A tumor like mass in the tail of the pancreas and so likely to be of neuroendocrine origin from islet cells. in functioning tumors, secretory diarrhea is common and other key features cud point to a def diagnosis. (-:
Related Self Assessment Question A 34-year-old woman has recurrent fainting spells induced by fasting. Her serum insulin levels during these episodes are markedly elevated. Correct statements regarding this patient's condition include which of the following? A. The underlying lesion is more commonly located in the body or tail of the pancreas. B. The underlying lesion is usually multifocal. C. These lesions are usually malignant. D. Serum calcium levels may be elevated. E. She should be screened for a coexistent pheochromocytoma. EXPLANATION: Insulin-secreting endocrine tumors of the pancreas produce paroxysmal nervous system manifestations that may be a consequence of hypoglycemia, although the blood glucose level may bear little relation to the severity of the symptoms, even in the same patient from episode to episode. Most insulinomas are single discrete tumors (90%). They are evenly distributed between the head, body, and tail of the pancreas. Patients with insulinoma in the setting of the MEN-1 syndrome (synchronous islet cell tumors of the pancreas, pituitary hyperplasia or adenomas, and parathyroid chief cell hyperplasia) are more likely to have multiple tumors throughout the pancreas. If a careful examination of the pancreas reveals one or more specific adenomas, these can be enucleated. The finding of an elevated serum calcium level would raise the suspicion of MEN-1 and parathyroid hyperplasia. Insulinomas are not associated with MEN-2, which consists of coexistent medullary thyroid cancer, parathyroid hyperplasia, and pheochromocytoma. Approximately 10% of insulinomas are malignant. Streptozocin, a potent antibiotic that selectively destroys islet cells, can be useful in controlling symptoms from unresectable malignant tumors of the islet cells but probably has little to offer in the definitive management of the typical benign islet cell insulinoma. The answer is D.
