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Toronto Notes 2019 Surgical Endocrinology
Treatment
• functionaltumour:resect • non-functionaltumour
■ >4 cm: resect
■ <4 cm: follow-up imaging in 6-12 mo, resect if >1 cm enlargement
Pancreas
INSULINOMA
• tumourthatsecretesinsulin
• mostcommonpancreaticendocrineneoplasm;10%associatedwithMEN1syndrome
Clinical Features
• Whipple’striad
• palpitations,trembling,diaphoresis,confusion,seizure,andpersonalitychanges
Investigations
• bloodwork:decreasedserumglucoseandincreasedseruminsulinandC-peptide • U/S,CT:insulinomasevenlydistributedthroughouthead,body,tailofpancreas
Treatment
• only10%aremalignant
• enucleationofsolitaryinsulinomasmaybedoneendoscopically
• tumours>2cmlocatedclosetothepancreaticductmayrequirepancreatectomyor
pancreaticoduodenectomy
GASTRINOMA
• tumoursecretinggastrin;causeofZollinger-Ellisonsyndrome
Clinical Features
• abdominalpain,PUD,severeesophagitis
• multipleulcersinatypicallocationsrefractoryofantacidtherapy
Investigations
• bloodwork:serumgastrinlevels(usually>1000pg/mL),secretinstimulationtest
• U/S, CT: 70-90% found in Passaro’s triangle (head of pancreas medially, 2nd portion of duodenum
inferiorly, and the confluence of the cystic and CBD superiorly)
• octreotidescintigraphyscan
Treatment
• 50%aremalignant
• surgicalresectionoftumourdependentonlocation
• non-surgicaltreatment:chemotherapy,somatostatinanalogues,interferon,andchemoembolization • ifinoperable,vagotomycanbeperformedforsymptomaticcontrol
VASOACTIVE INTESTINAL PEPTIDE-SECRETING TUMOUR
• tumoursecretingVIP;commonlylocatedinthedistalpancreasandmostaremalignantwhen diagnosed
Clinical Features
• severewaterydiarrheacausingdehydration,weakness,andelectrolyteimbalance
Investigations
• bloodwork:serumVIPlevels • U/S, CT
Treatment
• somatostatinanalogues
• surgicalresection/palliativedebulking
General Surgery and Thoracic Surgery GS61
Zollinger-Ellison Syndrome
Occurs because of gastric acid hypersecretion; patient experiences diarrhea and abdominal pain, as well as peptic disease and reflux disease
Hypertrophic Pyloric Stenosis
Non-bilious emesis in infants is the classic presentation
Whipple’s Triad
• Symptomatic fasting hypoglycemia • Serum glucose <50 mg/dL
• Relief of symptoms when glucose is
administered
Rule of 2s for Meckel’s Diverticulum • 2% of the population
• 2:1 male-to-female ratio
• Symptomatic in 2% of cases
• Found within 2 feet (10-90 cm) of the ileocecal (IC) valve
• 2 inches in length
• 2 inches in diameter
• 2 types of tissue (gastric, pancreatic) • Often present by 2 yr of age