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Insulinoma — RACP Adult Medicine MCQ

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HardEndocrinologyInsulinomaRACP Adult Medicine

A 45-year-old woman presents with recurrent hypoglycaemia, weight gain, and episodes of confusion. Fasting blood glucose is 2.1 mmol/L with an inappropriately elevated insulin of 45 mU/L and C-peptide of 1800 pmol/L. CT pancreas shows a 1.5 cm enhancing lesion in the body of the pancreas. What is the most appropriate management?

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Correct answer: C — Distal pancreatectomy and splenectomy

Whipple triad (symptoms of hypoglycaemia, documented low glucose, relief with glucose administration) with inappropriately elevated insulin and C-peptide (excluding exogenous insulin) and a pancreatic body/tail lesion is consistent with insulinoma. Distal pancreatectomy (with or without splenectomy) is the surgical treatment for body/tail lesions. >90% of insulinomas are benign.

Reference: ENETS – 2024 – Pancreatic NET Guidelines