Medical treatment of insulinomas: the role of diphenylhydantoin

Surgical removal of the insulinoma continues to be the treatment of choice. Medical therapy should be considered in patients who cannot undergo surgery. We are reporting our experience with regard to the efficacy of Diphenylhydantoin [DPH] in controlling hypoglycemia and suppressing insulin release in patients with insulinomas. DPH was administered orally at a dose of 300-400 mg/day to three patients with documented endogenous insulin excess. The first two patients received the drug temporarily during the preoperative period, with resolution of the hypoglycemic attacks, normalization of blood glucose, and reduction of insulin levels. Subsequent surgery confirmed the presence of insulin-secreting pancreatic tumor. Cure was achieved after excision of the tumor. The third patient represented a diagnostic and threrapeutic challenge. An insulin-secreting tumor located in the body of the pancreas was diagnosed in a patient with type 2 diabetes and end stage renal disease. The patient's poor cardiac function contra-indicated surgery. DPH resulted in an excellent sustained control of his blood sugar and a fall in insulin levels for several months. We believe that DPH is a potent inhibitor of insulin secretion and, thus, is suitable as a temporary therapeutic measure in the preoperative period of patients with insulinoma, as well as an alternative to surgery for those who are not surgical candidates

Epidemiology of diabetes mellitus in relation to other cardiovascular risk factors in Lebanon

A study of 2518 Lebanese subjects [1138 males, 1380 females] aged 30 years and over revealed an overall prevalence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance of 13.1% and 6.0% respectively. The prevalence of non-insulin-dependent diabetes mellitus was similar in both sexes, while impaired glucose tolerance was slightly higher among females; both increased steadily with age. The main risk factor was obesity [55% in males, 67% in females]. Participants with diabetes and impaired glucose tolerance were more likely to have heart disease, and had slightly higher blood pressure and serum triglycerides