A 30-year-old woman has recurrent episodes of sweating, palpitations, tremor, and confusion relieved promptly by eating. During a supervised 72-hour fast she develops symptoms with plasma glucose 38 mg/dL and insulin 12 microU/mL at the time of hypoglycaemia. C-peptide is appropriately elevated. CT pancreas shows a 9 mm lesion in the tail. What is the definitive management once localised?
- A Distal pancreatectomy with splenectomy in all cases
- B Total pancreatectomy
- C Enucleation of the tumour ✓
- D Lifelong diazoxide without surgery
Correct answer: C. Enucleation of the tumour
Explanation
Whipple's triad confirmed biochemically establishes endogenous hyperinsulinaemic hypoglycaemia, and a single small lesion in the tail fits sporadic benign insulinoma, the most common functional pancreatic neuroendocrine tumour. Enucleation is definitive for lesions away from the main pancreatic duct, preserving parenchyma. Distal pancreatectomy with splenectomy is not mandatory; spleen-preserving resection or enucleation avoids postsplenectomy sepsis risk. Diazoxide is a temporising measure used only when surgery is refused or the tumour is unresectable.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.