Analysis of diagnosis and treatment of insulinomas in multiple endocrine neoplasia Type 1(MEN-1) patients           ZHANG Tai-ping, ZHAN Han-xiang, ZHAO Yu-pei, et al. Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Corresponding author: ZHAO Yu-pei, E-mail: zhao8028@263. net
Abstract    Objectives    To investigate the strategy for diagnosis and surgical procedure of insulinoma in multiple endocrine neoplasia Type 1(MEN-1) patients based on a retrospective study; Methods    Medical records of patients diagnosed as MEN-1 related insulinoma from 1995 to 2010 in Peking Union Medical College Hospital were reviewed retrospectively. Clinical data was collected and statistically analyzed; Results    A total of 21 patients were diagnosed as MEN-1 related insulinomas, which including 6 males and 15 females, 6 of them had family history of pancreatic endocrine tumor or MEN-1. Multiple tumors were found in 9 cases; 2 cases were malignant insulinomas. Parathyroid was the most common affected gland in these patients, followed by pituitary and adrenal gland.19 patients underwent operations, the lesions were resected in one-stage or subsequent stage based on the severity of high hormone levels harmfulness. Tumor enucleation was the most common operative procedure. In total, 58 lesions were resected, of which 65.5% are < 1 cm in size. Pancreatic fistula (Grade B) occurred in 5 patients, all these patients recovered by conservative treatment; Conclusions    MEN-1 related insulinomas have special clinical characteristics, much more attentions should be paid to the high risk populations. Comprehensive exploratory surgery, intraoperative ultrasonography and blood glucose testing can help to remove all lesions. Other involvement glands can be treated in one or the following stage treatment, Surgeons should collaborate with relevant departments and some difficult cases can transferred to the big-volume centers.