Albu A, Zirnea A, Georgescu O, Terzea D, Jinga D, Fica S
Emergency University Elias Hospital, Endocrinology Department, Marasti nr. 17, Sect 1, Bucharest, Romania.
J Med Life. 2008 Apr-Jun;1(2):210-7.
Malignant insulinomas are rare tumors (10% of insulinomas) that often present as mnulticentric macro nodules with multiple liver metastases before diagnosis. We report the case of a 55 year old female with a medical history of severe hypoglycemic attacks for two months. Blood tests showed a decreased value of glycemia (30 mg/dl) associated with increased insulin level (l6 microU/ml) and an increased glycemia/insulinemia ratio of 1.87 supporting the diagnosis of insulinoma. Abdominal CT showed a 1.5 cm mass localized in the head of the pancreas with disseminated hepatic tumors, confirmed as neuroendocrine metastases by biopsy (which proved the presence of a malignant insulinoma). Primary hyperparathyroidism was diagnosed based on mild elevation of calcium (10.4 mg/dl) associated with a high level of PTH (71.2 pg/ml). The coexistence of the two endocrinopathies suggested the presence of type 1 multiple endocrine neoplasia (MEN 1). Because of multiple hepatic masses and liver function impairment, surgery and hepatic artery embolization were not performed. Somatostatin analog therapy was started with symptomatic control in the beginning, but rapid loss of beneficial effect. Finally, systemic chemotherapy with doxorubicin was administered, but the disease was progressive and after three months we decided to stop it. The patient died at home after one month, probably in hypoglycemic coma.
恶性胰岛素瘤是罕见肿瘤（占胰岛素瘤的10%），常在诊断前表现为多中心大结节并伴有多处肝转移。我们报告一例55岁女性病例，其有两个月严重低血糖发作的病史。血液检查显示血糖值降低（30mg/dl），同时胰岛素水平升高（16微单位/毫升），血糖/胰岛素血症比值为1.87升高，支持胰岛素瘤的诊断。腹部CT显示胰腺头部有一个1.5厘米的肿块，伴有散在的肝脏肿瘤，活检证实为神经内分泌转移瘤（证实存在恶性胰岛素瘤）。原发性甲状旁腺功能亢进根据钙轻度升高（10.4mg/dl）伴甲状旁腺激素水平升高（71.2pg/ml）而诊断。两种内分泌疾病并存提示存在1型多发性内分泌肿瘤（MEN 1）。由于存在多处肝脏肿块和肝功能损害，未进行手术及肝动脉栓塞。开始使用生长抑素类似物治疗，起初有症状控制，但很快失去有益效果。最后给予阿霉素全身化疗，但疾病仍进展，三个月后我们决定停止化疗。患者在一个月后在家中死亡，可能死于低血糖昏迷。
