Gopal Raju A, Acharya Shrikrishna V, Menon Sunil K, Bandgar Tushar R, Menon Padma S, Shah Nalini S
Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai 400 012, India.
Indian J Gastroenterol. 2010 Sep;29(5):205-8. doi: 10.1007/s12664-010-0051-y. Epub 2010 Oct 16.
To describe the clinical presentation, localization techniques, surgical procedures and outcome in patients with insulinoma.
Retrospective analysis of case records of patients diagnosed with insulinoma between January 1993 and June 2009 at a tertiary-care hospital was done. Seventeen patients underwent diagnostic 72-h fast. The sensitivity of computed tomography (CT) of pancreas was judged using intraoperative findings as the gold standard.
Twenty-six patients (19 women) with mean age 42.2 years (median age 39.5 years) with biochemical/imaging evidence of insulinoma were included. All patients who underwent 72-h fast developed symptomatic hypoglycemia within 48 h. The sensitivity and positive predictive value (PPV) of CT of pancreas was 68.4% and 92.8%, respectively. Twenty patients underwent surgery, of whom four were operated on without preoperative localization. Four patients had recurrence of symptoms. Of the six patients who were not operated upon, the lesion was localized in four.
This audit shows that all patients with insulinoma develop hypoglycemia within 48 h of fasting. CT of pancreas localizes the lesion in two thirds of cases and would be a useful initial investigation in patients with suspected insulinoma.
描述胰岛素瘤患者的临床表现、定位技术、手术方法及预后。
对1993年1月至2009年6月在一家三级医院确诊为胰岛素瘤的患者病历进行回顾性分析。17例患者接受了72小时禁食诊断。以术中发现为金标准判断胰腺计算机断层扫描（CT）的敏感性。
纳入26例（19例女性）平均年龄42.2岁（中位年龄39.5岁）有胰岛素瘤生化/影像学证据的患者。所有接受72小时禁食的患者在48小时内均出现症状性低血糖。胰腺CT的敏感性和阳性预测值（PPV）分别为68.4%和92.8%。20例患者接受了手术，其中4例在未进行术前定位的情况下进行了手术。4例患者症状复发。在6例未接受手术的患者中，4例病变得到定位。
本次审计表明，所有胰岛素瘤患者在禁食48小时内均会出现低血糖。胰腺CT在三分之二的病例中可定位病变，对于疑似胰岛素瘤的患者将是一项有用的初步检查。
