A 38-year-old man has three documented episodes of sweating, palpitations, confusion, and tremor, each relieved within minutes by eating. During a monitored fast he becomes symptomatic with blood glucose 2.1 mmol/L and simultaneous insulin level 25 microU/mL, C-peptide elevated. CT shows a 14 mm enhancing lesion in the pancreatic head. The definitive treatment is:
- A Lifelong diazoxide therapy
- B Pancreaticoduodenectomy
- C Enucleation of the lesion ✓
- D Distal pancreatectomy with splenectomy
Explanation
The biochemical profile confirms insulinoma: Whipple's triad of symptoms with hypoglycaemia, relief by glucose, plus inappropriately high insulin with raised A-peptide excluding exogenous insulin. About 90 percent of insulinomas are sporadic, solitary, under 2 cm, and benign. Small benign tumours anywhere in the gland, including the head as here, are treated by simple enucleation, which preserves maximal parenchyma. Formal resections such as pancreaticoduodenectomy are reserved for large tumours, suspected malignancy, or proximity precluding enucleation. Diazoxide is a temporising medical measure.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.