Localization of Endocrine Pancreatic Tumors

Volker Fendrich, MD ■ Matthias Rothmund, MD

The functioning endocrine tumors of the pancreas most often encountered are insulinomas and gastrinomas. Both tumors cause spectacular clinical syndromes, hyperinsulin-ism and the Zollinger-Ellison syndrome (ZES), respectively. The tumors are often difficult to localize because they are almost always smaller than 2 cm in diameter. Duodenal gastrinomas are usually even smaller than 1 cm. This is not the case for the rarer functioning endocrine pancreatic tumors such as glucagonomas, vasoactive intestinal polypeptide tumors, somatostatinomas, and the nonfunctioning tumors, which are usually large and easy to localize by standard localization techniques such as abdominal ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI). Therefore, this chapter focuses mainly on the localization of insulinomas and gastrinomas and includes only briefly the nonfunctioning tumors; the rarer tumors mentioned previously were excluded. Because the approach to localize insulinomas and gastrinomas differs in patients with the multiple endocrine neoplasia type 1 (MEN 1) syndrome compared with sporadic tumors, localization in MEN 1 is discussed separately.

However, localization techniques should not be used to make the diagnosis of hyperinsulinism or ZES. They should be used only after the diagnosis is made on the basis of the patient's history as well as clinical and laboratory data.

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