1976 Volume 19 Issue 1 Pages 77-85
A 46 year-old man was admitted to the hospital in February 1963 with a five and half year history of unconsciousness in the early morning. The serum response of insulin after 100g O-GTT was not high, and with the intravenous tolbutamide test, hypoglycemia appeared and loss of consciousness and convulsion occured.
In 1968 the diagnosis of insulinoma was made due to the typical symptoms of Whipple's triad being present.
A coeliac arteriography failed. Surgical operation of the insulinoma was tried, but it was unsuccessful as the tumor could not be found. After leaving the hospital the hypoglycemic attacks still continued.
At the second admission, the coeliac arteriography revealed an abnormal shadow suggesting a tumor at the head of the pancreas. Fasting level of serum IRI was 554uUjrni and a little higher response to IRI was found after 100g O-GTT. Since the patient refused to take the surgical operation, the treatment by streptozotocin was tried. A total dose of 16g streptozoticin was administered intravenously, but it had to be stopped due to the appearance of liver damage.
In December 1973, a sudden hematoemesis occurred at home and he was hospitalized immediately. The X-ray examination of the stomach showed the duodenal ulcer.
Resection of the pancreas and a gastrectomy were done in J anuary 1974, and the pancreas tumor was found at the head of pancreas. The histological diagnosis was insulinoma. The fasting levels of serum IRI and CPR of the radial artery just before the operation were 87pU/ml and 8.4ng/ml, but after extirpation of the insulinoma they decreased immediately to 15μU/ml/ and 1.5ng/ml, respectively and the blood glucose level rose to 213 mg/dl from 138mg/dl.
The serum IRI and CPR of 100g O-GTT after operation was normalized. The IRI and CPR contents of the insulinoma and the normal pancreatic tissue were 9.73Uig tissue and 44.1μg/g and 0.704U/g, 3.90μgig, respectively. The dialysed fluids of the acid alcohol extract of the tumor and adjacent normal pancreatic tissue were fractionated by Bio-Gel P-30 column chromatography and eluted by 3M acetic acid. The insulin, proinsulin and C-peptide components of the insulinoma were markedly elevated compared with those of the normal pancreatic tissue and their total amount in tissue increased in the insulinoma, too.
