Koshy Anoopa A, Gordon Ilyssa O, Van Ha Thuong G, Kaplan Edwin L, Philipson Louis H
University of Chicago Medical Center, Chicago, IL, USA.
J Investig Med High Impact Case Rep. 2013 Jan 1;1(1):2324709612473274. doi: 10.1177/2324709612473274. eCollection 2013 Jan-Mar.
A 56-year-old woman presented to our clinic for recurrent hypoglycemia after undergoing resection of an incidentally discovered nonfunctional pancreatic endocrine tumor 6 years ago. She underwent a distal pancreatectomy and splenectomy, after which she developed diabetes and was placed on an insulin pump. Pathology showed a pancreatic endocrine neoplasm with negative islet hormone immunostains. Two years later, computed tomography scan of the abdomen showed multiple liver lesions. Biopsy of a liver lesion showed a well-differentiated neuroendocrine neoplasm, consistent with pancreatic origin. Six years later, she presented to clinic with 1.5 years of recurrent hypoglycemia. Laboratory results showed elevated proinsulin, insulin levels, and c-peptide levels during a hypoglycemic episode. Computed tomography scan of the abdomen redemonstrated multiple liver lesions. Repeated transarterial catheter chemoembolization and microwave thermal ablation controlled hypoglycemia. The unusual features of interest of this case include the transformation of nonfunctioning pancreatic endocrine tumor to a metastatic insulinoma and the occurrence of atrial flutter after octreotide for treatment.
一名56岁女性6年前因偶然发现的无功能胰腺内分泌肿瘤接受切除术后，因反复低血糖前来我院就诊。她接受了胰体尾切除术和脾切除术，术后患上糖尿病并使用胰岛素泵。病理显示为胰腺内分泌肿瘤，胰岛激素免疫染色阴性。两年后，腹部计算机断层扫描显示肝脏有多个病灶。肝脏病灶活检显示为高分化神经内分泌肿瘤，符合胰腺来源。六年后，她因1.5年的反复低血糖前来就诊。实验室检查结果显示，在低血糖发作期间，胰岛素原、胰岛素水平和C肽水平升高。腹部计算机断层扫描再次显示肝脏有多个病灶。反复经动脉导管化疗栓塞和微波热消融控制了低血糖。该病例的特殊之处包括无功能胰腺内分泌肿瘤转变为转移性胰岛素瘤，以及使用奥曲肽治疗后发生心房扑动。
