A 42-year-old woman has repeated episodes of confusion and sweating, all aborted by eating. During a supervised 72-hour fast she develops neuroglycopenia with serum glucose 40 mg/dL accompanied by insulin 14 microU/mL and detectable C-peptide. Contrast CT demonstrates a 1.2 cm hypervascular lesion in the pancreatic head. The most appropriate definitive management is:

• A Lifelong diazoxide therapy
• B Pancreaticoduodenectomy
• C Distal pancreatectomy with splenectomy
• D Enucleation of the lesion ✓

Explanation

The biochemical profile of endogenous hyperinsulinaemic hypoglycaemia with suppressed ketones localises to an insulinoma, the most common functioning pancreatic neuroendocrine tumour. Small, superficial, benign insulinomas away from the main pancreatic duct are managed by enucleation, which preserves parenchyma. Diazoxide controls symptoms preoperatively or in unresectable disease but is not curative. Radical resection is reserved for large tumours or proven malignancy near the duct.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.