Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Presbyterian Medical Group, Endocrine Surgery, Albuquerque, NM, USA.
Endocrine. 2018 Sep;61(3):422-427. doi: 10.1007/s12020-018-1633-1. Epub 2018 Jun 19.
It has been proposed that rebound hyperglycemia after resection of insulinoma indicates a biochemical cure. However, there is scant objective data in the literature on the rate and need for intervention in hyperglycemia in patients undergoing resection of insulinoma. The goal of our study was to evaluate the rate of postoperative hyperglycemia, any predisposing factors, and the need for intervention in a prospective cohort study of all patients undergoing routine glucose monitoring.
A retrospective analysis of 33 patients who had an insulinoma resected and who underwent routine postoperative monitoring of blood glucose (every hour for the first six hours then every four hours for the first 24 h) was performed. Hyperglycemia was defined as glucose greater than 180 mg/dL (10 mmol/l).
Twelve patients (36%) developed hyperglycemia within 24 h (range 1-16 h). In patients with hyperglycemia, the mean maximum plasma glucose level was 221.5 mg/dL (range 97-325 mg/dL) (12.3 mmol/l), and four (33%) patients were treated with insulin. There was no significant difference in age, gender, body mass index (BMI), tumor size, biochemical profile, or surgical approach and extent of pancreatectomy between patients who developed hyperglycemia and those who did not. Pre-excision and post-excision intraoperative insulin levels were evaluated in 14 of 33 patients. The percentage decrease of the intraoperative insulin levels was not significantly different between patients who developed hyperglycemia and those who did not. All patients with postoperative hyperglycemia had normalization of their glucose levels, and none were discharged on anti-hyperglycemic agents.
Hyperglycemia is common after insulinoma resection, and a subset of patients require transient treatment with insulin.
有人提出，胰岛素瘤切除术后的反弹性高血糖表明生化治愈。然而，在接受胰岛素瘤切除术的患者中，关于术后高血糖的发生率和干预需求的文献中客观数据很少。我们的研究目的是评估所有接受常规血糖监测的患者中术后高血糖的发生率、任何潜在的危险因素以及干预的必要性。
对 33 例接受胰岛素瘤切除术并进行常规术后血糖监测（前 6 小时每小时监测一次，前 24 小时每 4 小时监测一次）的患者进行回顾性分析。高血糖定义为血糖>180mg/dL（10mmol/L）。
12 例患者（36%）在 24 小时内发生高血糖（范围 1-16 小时）。在高血糖患者中，平均最大血浆葡萄糖水平为 221.5mg/dL（范围 97-325mg/dL）（12.3mmol/L），有 4 例（33%）患者接受胰岛素治疗。发生高血糖和未发生高血糖的患者在年龄、性别、体重指数（BMI）、肿瘤大小、生化特征、手术方法和胰腺切除术范围方面无显著差异。在 33 例患者中的 14 例评估了术前和术后术中胰岛素水平。发生高血糖和未发生高血糖的患者术中胰岛素水平下降的百分比无显著差异。所有术后高血糖患者的血糖水平均恢复正常，且均未出院服用抗高血糖药物。
胰岛素瘤切除术后高血糖很常见，一部分患者需要短暂的胰岛素治疗。
