1976 Volume 19 Issue 1 Pages 93-102
A case of insulinoma in a 66 year-old man was associated with a annular pancreas, hare-lip and an anomaly of the splenic artery. A hypoglycemic attack, characterized by loss of consciousness, was first experienced in July 1971, when he was treated for hypertension.
On admission, October 1971, he suffered from frequent hypoglycemic attacks with involuntary movement and bizarre behavior.
The fasting blood sugar was about 50mg/dl (Hagedorn-Jensen's method) and the fasting immunoreactive insulin (IRI) was about 30μU/ml.
Intravenous tolbutamide test (Tolbutamide 1g) and oral L-leucine (200mg/kg) test revealed significant decrease in blood sugar with loss of consciousness, and the maximum increase of serum IRI was about 100μU/ml.
Arteriography of the caeliac artery did not reveal the presence of a pancreatic tumor, but the abnormal routes of the splenic and hepatic arteries were demonstrated.
The presence of an annular pancreas was diagnosed preoperatively by means of the hypotonicduodenography and endoscopic pancreatography.
Resection of the tail of the pancreas, containing 10×8mm tumor was performed with a splenectomy, and then the hypoglycemic attacks disappeared.
Biological Insulin content of the tumor tissue was 11.2U/g, not as abundant as compared with the insulin content of the pancreatic tissue around the tumor, 2.9U/g, including the exocrine gland.
The β-granule staining, electronmicroscopic observation, and immunofluorescent studies of insulin using FITC labelled anti-insulin, antibody did not reveal active insulin secretion of the tumor tissue.
