Functioning pancreatic adenomas in infants and children

1. 1. The world literature on functioning islet cell adenomas of the pancreas in children under the age of 15 years has been reviewed and a new case added. 2. 2. The clinical, laboratory, operative, and autopsy findings in these cases have been studied in an attempt to establish criteria to differentiate functioning insulinoma from idiopathic spontaneous hypoglycemia of infancy and childhood. 3. 3. No clinical or laboratory test was found that could differentiate these 2 conditions. 4. 4. The age at the onset of symptoms is the most important diagnostic criterion. No gross tumor was reported in patients under 4 years of age. 5. 5. No familial tendency was reported nor was there any sex preponderance. 6. 6. Conservative therapy is recommended for children under 4 years of age with operation reserved for those patients whose disease is not controlled with ACTH. Surgical exploration is advised for all children over 4 years of age after an evaluation of response to ACTH has been made. In this age group blind pancreatectomy is indicated if no gross tumor is found and the preoperative response to ACTH was unsatisfactory.