Hyperinsulinism and neuromuscular disorders; a consideration of the association of pancreatic adenoma with wasting states

Five cases, one reported herein, have been described in which progressive generalized muscle wasting, muscle fasciculations, increased myotatic irritability, and progressive motor disability were in evidence. In all of these cases, a pancreatic islet cell adenoma was present. In four of them arrest of the symptoms of muscular disease followed upon surgical removal of the islet cell adenoma. In the other case the tumor was not observed until postmortem examination, and in that case there was also histologic evidence of widespread and severe degeneration in the anterior horn cells of the spinal cord. The observations give rise to conjecture upon the possibility that endocrine dysfunction plays a part in the genesis of progressive muscular atrophy.

Adenoma of the islets of Langerhans

An adenoma of the islets of Langerhans may be found anywhere in the pancreas but is more common in the body and tail, and more than one tumor may be present. When such a tumor produces insulin the symptoms observed are those of hyperinsulinism, varying from pallor, sweating, weakness and amnesia in mild cases to coma and convulsions in the more severe. The diagnosis rests largely on Whipple's triad, namely, the onset of symptoms during the fasting period or after exertion, sugar content in the blood of less than 50 mg. per 100 cc. during an attack, and immediate relief of symptoms upon the administration of glucose in one form or another. Surgical removal of an adenoma is the only known cure, and unless it is done the patient will eventually die of the effects of prolonged hyperinsulinism. The procedure entailed may be relatively simple, or fraught with great difficulties and postoperative complications of a major nature. The literature indicates that there has been a mortality rate of 8 or 9 per cent associated with the surgical treatment of this condition.

Surgical considerations in diseases of the pancreas

Present data indicate that surgical treatment of pancreatitis is most successful in cases in which the disease is caused by extrahepatic disease of the biliary tract. Operation is also effective in cases of islet cell tumors, cysts, lithiasis, trauma and annular pancreas. Results seem to justify radical operation for early carcinoma of the ampulla of Vater and pancreas. The value of surgical treatment in other lesions of the pancreas is doubtful.