有癫痫病史的胰岛素瘤：仍是胰岛素瘤早期诊断中可能存在的误导因素。

Murakami Takaaki, Yamashita Takafumi, Yabe Daisuke, Masui Toshihiko, Teramoto Yuki, Minamiguchi Sachiko, Hirota Keisho, Ogura Masahito, Nagashima Kazuaki, Inagaki Nobuya

Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan.

Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Japan.

Intern Med. 2017 Dec 1;56(23):3199-3204. doi: 10.2169/internalmedicine.8932-17. Epub 2017 Oct 11.

A delayed diagnosis of insulinoma remains a clinical issue. Hypoglycemic symptoms can mimic neuropsychiatric disorders such as epilepsy. A 27-year-old woman with a history of epilepsy and anti-epileptic drugs (AEDs) developed repeated seizures and neuropsychiatric symptoms after a 9-year asymptomatic interval. She had received transient treatment with AEDs before the possibility of hypoglycemia was considered. Following a clinical diagnosis of insulinoma, distal pancreatectomy was performed; her seizures didn't occur again. The early diagnosis of insulinoma requires vigilance not only for hypoglycemia in patients with neuropsychiatric symptoms but also for the possible masking effects of a history of epilepsy and preceding AED usage.

胰岛素瘤的延迟诊断仍是一个临床问题。低血糖症状可能会模仿神经精神疾病，如癫痫。一名有癫痫病史且服用抗癫痫药物（AEDs）的27岁女性，在9年无症状期后出现了反复癫痫发作和神经精神症状。在考虑低血糖可能性之前，她曾接受过AEDs的短暂治疗。在临床诊断为胰岛素瘤后，进行了胰体尾切除术；她的癫痫发作未再出现。胰岛素瘤的早期诊断不仅需要警惕神经精神症状患者的低血糖情况，还需要注意癫痫病史和先前使用AEDs可能产生的掩盖作用。