Functioning Insulinoma—Incidence, Recurrence, and Long-Term Survival of Patients: A 60-Year Study
Section snippets
Study Population.
To identify the study cohort, we reviewed the entire medical records of all patients with histologically confirmed insulinoma for the period from the first identified case in 1927 through 1986. Although some of these records had been reviewed previously for other purposes,2, 15, 16, 17, 18, 19 this report represents the only comprehensive assessment of all patients with insulinoma at the Mayo Clinic during 6 decades for the purpose of determining the epidemiologic features of this disorder.
Distribution of Cases by Age, Gender, and Period of Study.
For the total cohort of patients (N = 224), the median age (and range) at the time of surgical diagnosis was 47 (8 to 82) years, and 59% were female patients (Table 1). We found no evidence that age or gender distribution among Mayo Clinic patients with insulinoma varied during the study period (1927 through 1986). In addition, no difference was noted between male and female patients with respect to age or year of histologic diagnosis.
Incidence of Insulinoma in Olmsted County.
During the 6-decade period of observation, eight cases of
DISCUSSION
Before this study, data about the incidence of insulinoma in a geographically defined population, the risk of recurrence of insulinoma, and the long-term survivorship of patients with insulinoma were not available. With such knowledge, primary-care physicians, internists, endocrinologists, neurologists, and psychiatrists who must recognize the disorder, radiologists who attempt to localize the lesions, surgeons who remove them, and oncologists who treat malignant insulinomas would be better
CONCLUSION
Insulinoma is a rare disorder with an estimated incidence of 4 cases per 1 million person-years; however, it is less rare than previously suspected. The risk of recurrence of this disorder spans 2 decades and is high among patients with MEN I. After successful removal of the insulinoma, cure can be anticipated in most patients. For those with benign insulinoma, a normal life span can be expected after successful surgical resection.
ACKNOWLEDGMENT
We thank Margaret Telander for collection of the study data, C. Mary Beard for supervision of data collection and follow-up, Chu-Pin Chu for assistance in data analysis, and Sondra L. Buehler for assistance in the preparation of the submitted manuscript.
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This study was supported in part by Research Grant AR 30582 from the National Institutes of Health, Public Health Service. Dr. Ballard is supported in part by a Career Development Award from the Merck, Sharp & Dohme/Society for Epidemiologic Research Clinical Epidemiology Fellowship Program.