[Insulinomas in children (characteristics of clinical picture and surgical treatment)]

Abstract

The paper treats of the main characteristics of the clinical picture and diagnosis of insulinoma in children as compared to adults. Seven children were operated on for insulinomas at the Surgery Department of the All-Union Research Endocrinology Center of the USSR AMS. The clinical course of insulinomas in children was characterized by a short-term disease history, the lack of overweight, and the convulsive syndrome as the leading symptom of hypoglycemia. As to the diagnostic tests, the fasting test appeared not desirable in the majority of children because of the low blood content of glucose in the morning hours and development of a marked hypoglycemic attack. Examination of immunoreactive insulin was not so indicative as in adults. During convulsions, electroencephalography in children was not feasible. Visceral arteriography turned out a reliable method of topical diagnosis of insulinoma in children. Tumor was most frequently located in the tail of the pancreas. The postoperative period in children ran a more favourable course than in adults. No clinical signs of pancreatitis were recorded. According to follow-up studies, the patients did not show any clinical or biochemical signs of hypoglycemia. Histological examination demonstrated that children had mainly neoplasms from beta-cells of islets of Langerhans. It is suggested that children have very low power to adjust themselves to acute and chronic hypoglycemia as compared to adults.