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June 25, 1982

The Loss of Santa

JAMA. 1982;247(24):3310. doi:10.1001/jama.1982.03320490014008

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My sympathies were drawn to this man: with his enormous girth, he looked like Santa Claus, but he had to eat incessantly in order to survive. His was an unusual story of attacks of ravenous hunger, profuse sweating, and profound weakness that would occur before breakfast and several hours after meals. The attacks did not allow him to exercise, and could be prevented or aborted by eating foods high in carbohydrates. As a consequence, he carried 270 lb on a 6-ft frame.

"You understand, Mr Willoughby, that your doctors believe that you may have an insulinoma, a growth in the pancreas. This produces excessive amounts of the hormone insulin, which could lead to your symptoms." He nodded. "They would like to perform an arteriogram to see if you have this condition."

Insulinomas are often too small to be detected by the surgeon in the operating suite, and portions of the