Kalafat Hasan, Mihmanli Ismail, Saribeyoglu Kaya, Belli Ahmet
Department of General Surgery, Istanbul University Cerrahpasa Medical Faculty, Turkey.
Hepatogastroenterology. 2007 Jun;54(76):1256-8.
A 44-year-old woman was admitted with obvious symptoms of hypoglycemia and Whipple's triad during a 6-month period. The glucose level was as low as 32 mg/dL and insulin/glucose ratio greater than 0.5 after fasting. Abdominal magnetic resonance imaging (MRI) studies revealed a pancreatic mass at the head, 2 cm in diameter that was not suggesting because of hypointensity. Selective angiography and somatostatin-receptor scintigraphy did not reveal insulinoma. During laparotomy the tumor was palpated on the ventral surface of pancreas and intraoperative ultrasound accurately localized it. Doppler ultrasound examination clearly revealed the hypervascularity of the tumor, which was suggesting an insulinoma. After the tumor enucleation, blood glucose level increased to normal ranges. Histopathological examination revealed benign, well differentiated neuroendocrine tumor, insulinoma. The postoperative recovery was uneventful and the patient is still symptom free during a follow-up period of 6 months. Doppler ultrasound may be a simple but efficient tool for the differential diagnosis of insulinoma. If the clinical symptoms and findings suggest clearly an insulinoma, intraoperative Doppler ultrasound examination seems to be a simple but the most sensitive diagnostic method.
一名44岁女性在6个月期间出现明显的低血糖症状及Whipple三联征。空腹血糖水平低至32mg/dL，胰岛素/血糖比值大于0.5。腹部磁共振成像（MRI）检查显示胰头有一2cm直径的肿块，因其低信号未提示异常。选择性血管造影和生长抑素受体闪烁扫描未发现胰岛素瘤。剖腹手术时在胰腺腹侧面可触及肿瘤，术中超声准确对其定位。多普勒超声检查清晰显示肿瘤血管丰富，提示为胰岛素瘤。肿瘤摘除后，血糖水平升至正常范围。组织病理学检查显示为良性、高分化神经内分泌肿瘤，即胰岛素瘤。术后恢复顺利，患者在6个月的随访期内仍无症状。多普勒超声可能是用于胰岛素瘤鉴别诊断的一种简单而有效的工具。如果临床症状和检查结果明确提示胰岛素瘤，术中多普勒超声检查似乎是一种简单但最敏感的诊断方法。
