Insulinoma is a rare functional neoplasm of the pancreas. Most of the affected dogs are old. The clinical signs include those of hyperinsulinism as well as those of increased discharge of the sympathetic nervous system. The most reliable diagnostic test for this condition is demonstration of an inappropriately high serum insulin level in the presence of hypoglycemia. Surgical exploration to confirm the diagnosis, stage the disease, and remove neoplastic tissue is the treatment of choice. Blood glucose must be closely monitored during the procedure. Ultrasonography seldom locates the tumor but may reveal metastasis. The short-term prognosis for dogs with insulinoma is good. However, the long-term prognosis is grave, partly because of the advanced age of most of the patients. This article presents a stepwise protocol for the symptomatic management of insulinoma cases in which surgery is declined or clinical signs recur after initial surgical treatment.
