Diagnostics and treatment of organic hyperinsulinism – experience in 105 cases
Authors:
J. Škrha 1,5; J. Šváb 2; Krušina L † 3; J. Dušková 4; J. Hilgertová 5; R. Keil 6
Authors place of work:
Univerzita Karlova v Praze, 1. lékařská fakulta, III. interní klinika
1; Univerzita Karlova v Praze, 1. lékařská fakulta, I. chirurgická klinika
2; Univerzita Karlova v Praze, 1. lékařská fakulta, II. chirurgická klinika
3; Univerzita Karlova v Praze, 1. lékařská fakulta, Ústav patologie
4; Univerzita Karlova v Praze, 1. lékařská fakulta, Laboratoř pro endokrinologii a metabolismus
5; Univerzita Karlova v Praze, 2. lékařská fakulta, Interní klinika
6
Published in the journal:
Čas. Lék. čes. 2009; 148: 389-394
Category:
Original Article
Summary
Background.
Organic hyperinsulinism causes hypoglycaemia manifesting mainly in the fasting state. We summarize our experience with diagnosis and treatment of 105 patients with organic hyperinsulinism.
Methods and results.
The diagnosis was confirmed in all patients by spontaneous hypoglycemia and neuroglycopenic symptoms, both developed during fasting test. Endoscopic ultrasonography was the most reliable method for the insulinoma localization (77% of insulinomas confirmed by surgery in the same location within the pancreas), less positive results were obtained by digital subtraction angiography (29%) and still less was found by computed tomography (18%). The localization remains unclear in about 20–25% of insulinomas despite of combined different exploring techniques. Surgical removal of insulinoma by enucleation is the best way of treatment, in some cases laparoscopic removal is a method of choice. From total number of 95 surgically treated patients the successful removal of insulinoma was performed in 84 patients (88%) and another 3 had histopathology diagnosis of micronodular polyadenomatosis.
Conclusions.
Insulinoma was not found during surgery and subsequent thorough histopathology investigation of the whole resecate in 8 patients which have to be treated like other non-surgically treated patients by diazoxide together with diabetic diet.
Key words:
insulinoma, neuroglycopenia, fasting test, tumor enucleation.
Zdroje
1. Service FJ, McMahon MM, OęBrien P, Ballard DJ. Functioning insulinoma – incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 1991; 66: 711–719.
2. Škrha J. Hypoglykemický syndrom, 1. vydání. Praha: Grada Publishing, 2001, 114 s.
3. Šrámková J, Páv J, Engelberth O. Inordinately high levels of serum immunoreactive insulin in monoclonal immunoglobulinemia. Diabetes 1975; 24: 214–224.
4. Dizon AM, Kowalyk S, Hoogwerf BJ. Neuroglycopenic and other symptoms in patients with insulinoma. Am J Med 1999; 106: 307–310.
5. Placzkowski KA, Vella A, Thompson GB, Grant CS, Reading CC, Charboneau JW, Andrews JC, Lloyd RV, Service FJ. Secular trends in the presentation and management of functionning insulinoma at the Mayo Clinic, 1987–2007. J Clin Endocrinol Metab 2009; 94: 1069–1073.
6. Quinckler M, Strelow F, Pilich M, Rohde W, Biering H, Lochs H, Gerl H, Strasburger CJ, Ventz M. Assessment of suspected insulinoma by 48-hour fasting test: A retrospective monocentric study of 23 cases. Horm Metab Res 2007; 39: 507–510.
7. Škrha J, Šindelka G, Melenovský V, Kábrt J. Od hyperinzulinismu k psychiatrii. Diabetologie, metabolismus, endokrinologie, výživa 1998; 1: 10–11.
8. Bottger TC, Weber W, Beyer J, Junginger T. Value of tumor localization in patients with insulinoma. World J Surg 1990; 14: 107–112.
9. Liu H, Zhang SZ, Wu YL, Fang HQ, Li JT, Sheng HW, Wang Y. Diagnosis and surgical treatment of pancreatic endocrine tumors in 36 patients: a single-center report. Chinese Med J 2007; 120: 1487–1490.
10. Rösch T, Lightdale CJ, Botet JF, Boyce GA, Sivak MV, Yasuda K, Heyder N, Palazzo L, Dancygier H, Schisdziarra V, Classen M. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 1992; 326: 1721–1726.
11. Sotoudehmanesh R, Hedayat A, Shirazian N, Shahraeeni S, Ainechi S, Zeinali F, Kolahdoozan S. Endoscopic ultrasonography (EUS) in the localization of insulinoma. Endocrine 2007; 31: 238–241.
12. Vinik AI, Delbridge L, Moattari R, Cho K, Thompson N. Transhepatic portal vein cathetrization for localization of insulinomas: a ten-year experience. Surgery 1991; 109: 1–11.
13. Guettier JM, Kam A, Chang R, Skarulis MC, Cochran C, Alexander HR, Libutti SK, Pingpank JF, Gorden P. Localization of insulinomas to region sof the pankreas by intraarterial kalcium stimulation: The NIH experience. J Clin Endocrinol Metab 2009; 94: 1074–1080.
14. Noldge G, Weber MA, Ritzel RA, Werner MJ, Kauczor HU, Grenacher L. Invasive diagnostic procedures for insulinomas of the pankreas. Radiologe 2009; 49: 224–232.
15. Šváb J, Pešková M, Krušina L, Škrha J, Šindelka G. Naše zkušenosti s chirurgickou léčbou inzulinomu. Rozhledy v chirurgii 2001; 80: 77–81.
16. Arbuckle JD, Kekis PB, Lim A, Jackson JE, Todd JF, Lynn J, Isla A. Laparosacopic management of insulinomas. Br J Surg 2009; 96: 185–190.
17. Luo Y, Liu R, Hu MG, Mu YM, An LC, Juany ZQ. Laparoscopic surgery for pancreatic insulinomas: A single-institution experience of 29 cases. J Gastrointest Surg 2009; 13: 945–950.
18. Šváb J, Škrha J, Gürlich R, Maruna P, Krška Z, Trča S, Hořejš J, Bárta M. Laparoskopická diagnostika a léčba organického hyperinzulinismu – naše první zkušenosti. Rozhledy v chirurgii 2005; 84: 70–74.
19. Deprez PH, Claessens A, Borbath I, Gigot JF, Maiter D. Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma. Acta Gastroernterol Belgova 2008; 71: 333–337.
20. De Lellis RA, Lloyd R., Heitz PU, Eng Ch.: Pathology an genetics of tumours of endocrine organs. Lyon: IARC Press 2004.
21. Dušková J, Škrha J, Štolba P. Neuroendokrinní karcinom pankreatu se syndromem hyperinsulinismu. Čas Lék čes 1994; 133: 603–605.
Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
Journal of Czech Physicians
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Pheochromocytoma: diagnosis and treatment
- Diagnostics and treatment of organic hyperinsulinism – experience in 105 cases
- Hypertensive crisis – the present view
- Electrocardiography of yesterday and today