低血糖的一个恶性病因：转移性胰岛素分泌性胰腺神经内分泌癌。
A malignant cause of hypoglycaemia: a metastatic insulin-secreting pancreatic neuroendocrine carcinoma.
作者信息
Sandoval Mark Anthony, Pagsisihan Daveric, Berberabe A'Ericson, Palugod-Lopez Elaine Gayle
机构信息
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
出版信息
BMJ Case Rep. 2016 Mar 18;2016:bcr2016214702. doi: 10.1136/bcr-2016-214702.
Most cases of insulinomas are benign. We report a case of a malignant form of insulinoma. A 46-year-old man presented with behavioural changes associated with hypoglycaemia. Diagnostic work up revealed high serum insulin, high C-peptide and low glucose levels, compatible with endogenous hyperinsulinaemic hypoglycaemia. CT imaging of the abdomen revealed a pancreatic head mass and multiple liver masses. Biopsy of the pancreatic mass revealed a grade three pancreatic neuroendocrine carcinoma. Histological analysis of a liver mass showed that it was identical to the pancreatic mass, confirming its metastatic nature. The patient underwent distal pancreatectomy with en bloc splenectomy. There was persistence of hypoglycaemic symptoms after removal of the pancreatic mass, suggesting that the liver metastases were also functioning. Symptoms were controlled by diazoxide and octreotide long-acting release. The patient is already 1 year postsurgery with no recurrence of severe hypoglycaemia, and he has good functional capacity and has returned to his office job.
大多数胰岛素瘤病例是良性的。我们报告一例恶性胰岛素瘤病例。一名46岁男性出现与低血糖相关的行为改变。诊断检查发现血清胰岛素水平高、C肽水平高且血糖水平低，符合内源性高胰岛素血症性低血糖。腹部CT成像显示胰头肿块和多个肝脏肿块。胰腺肿块活检显示为三级胰腺神经内分泌癌。肝脏肿块的组织学分析表明其与胰腺肿块相同，证实了其转移性质。患者接受了胰体尾切除术并整块切除脾脏。切除胰腺肿块后低血糖症状持续存在，提示肝转移灶也有功能。症状通过二氮嗪和长效奥曲肽得到控制。患者术后已1年，未再次出现严重低血糖，功能状态良好，已重返办公室工作。
Zotero 插件