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‘ workplace: 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: Čas. Lék. čes. 2009; 148: 389-394
Category: Original Article

Overview

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.


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