Ambulatory of Gonadal and Adrenal Diseases, Endocrinology Unit, University Hospital of Brasilia, Brazil.
Gynecol Endocrinol. 2012 Aug;28(8):633-6. doi: 10.3109/09513590.2011.650756. Epub 2012 Feb 2.
Insulinomas are rare pancreatic β-cell tumors with an estimated incidence of 1:250.000 persons/year. We present a novel case of insulinoma manifesting immediately after childbirth. Eight days after delivery, a 21-year-old, previously healthy woman presented paresthesia in hands, upper and lower limbs muscle weakness with difficult walking, which worsened during breastfeeding sessions. Laboratory tests showed blood glucose levels between 37 and 55 mg/dL with inappropriately normal insulin levels (7.78 μUI/mL; normal range: 5-29). An abdominal computed tomography showed a nodular lesion measuring 2 cm at the head of the pancreas. Tumor enucleation resulted in complete resolution of hypoglycemia. Histopathological and immunohistochemical analysis were consistent with an insulinoma. About 27 cases of insulinoma associated with pregnancy have been reported to date, mostly diagnosed before the 16th week. The beginning of symptoms soon after delivery is less common. Understanding the interactions between pancreatic β-cell function and all the physiological metabolic and hormonal adaptations associated with gestation is essential for the adequate management of hypoglycemic disorders in pregnant women.
胰岛素瘤是一种罕见的胰腺β细胞肿瘤，估计发病率为 1:250000 人/年。我们报告了一例新的胰岛素瘤病例，该病例在分娩后立即出现。一位 21 岁、既往健康的女性在分娩后 8 天出现手部感觉异常、上下肢肌无力，行走困难，在哺乳过程中症状加重。实验室检查显示血糖水平在 37 至 55mg/dL 之间，而胰岛素水平（7.78μUI/mL；正常范围：5-29）不适当正常。腹部 CT 显示胰腺头部有一个 2cm 的结节性病变。肿瘤切除术导致低血糖完全缓解。组织病理学和免疫组织化学分析与胰岛素瘤一致。迄今为止，已有约 27 例与妊娠相关的胰岛素瘤病例被报道，其中大多数在第 16 周前被诊断。分娩后不久开始出现症状的情况较少见。了解胰腺β细胞功能与妊娠相关的所有生理代谢和激素适应之间的相互作用对于孕妇低血糖症的适当管理至关重要。
