A CASE OF MULTIPLE ENDOCRINE NEOPLASIA TYPE I WITH MULTIPLE INSULINOMA AND PITUITARY ADENOMA

Abstract

Generally insulinomas occur solitary and are candidates for operation with a good prognosis by complete resection. But it involved by MEN type 1, such insulinomas have sometimes multiple nodules, making complete excision difficut. It is important to make the correct diagnosis preoperatively. A 38-year-old man developed hypoglycemic shock when a non-functioning pituitary adenoma was removed at the hospital. Preoperative procedures for the diagnosis of localization such as arteriography, computed tomography, magnetic resonance imaging, percutaneous transhepatic portal catheterization (PTPC) indicated that the tumor was solitary insulinoma arising in the tail of the pancreas, which, whiout any other nodule could be detected by the intraoperative sonography. No other nodules besides the main tumor were detected by intraoperative observation and palpation, so distal pancreatectomy was performed.
Histopathological examination of the resected specimen revealed three small nodules besides the main tumor, and all were diagnosed as insulinoma. As MEN type 1 insulinomas are sometimes found with multiple small nodules like our case, intraoperative tumor localization with carefull observation and high sensitive ultrasonography, as well as preoperative one, is regarded important for the more accurate localization of the insulinoma.