胃旁路手术后以胰岛素原为主的胰腺神经内分泌肿瘤所致低血糖症
PROINSULIN-PREDOMINANT PANCREATIC NEUROENDOCRINE TUMOR-INDUCED HYPOGLYCEMIA AFTER ROUX-EN-Y GASTRIC BYPASS SURGERY.
作者信息
Edwards Khary, de La Portilla Lori, Mirza Faryal S, Luthra Pooja
出版信息
AACE Clin Case Rep. 2019 Aug 15;5(6):e339-e343. doi: 10.4158/ACCR-2019-0148. eCollection 2019 Nov-Dec.
OBJECTIVE
To present a case of recurrent hypoglycemia following Roux-en-Y gastric bypass (RYGB) surgery whose etiology was determined to be a proinsulin-predominant pancreatic neuroendocrine tumor (a proinsulinoma).
METHODS
A case report along with a brief discussion and review of the pertinent literature is presented.
RESULTS
The patient is a 62-year-old female who presented with symptomatic hypoglycemia 11 years after RYGB surgery. Initial workup revealed low insulin levels with elevated proinsulin levels. A 72-hour fast confirmed the presence of proinsulin-induced hypoglycemia secondary to a pancreatic neuroendocrine tumor (PNET). She underwent distal pancreatectomy with splenectomy and a PNET tumor was successfully removed with resolution of her symptoms.
CONCLUSION
Hypoglycemia after RYGB surgery is a well-established syndrome. While there are several etiologies for this, PNETs (including proinsulinomas) should be considered in the differential diagnosis in this population. Proinsulinomas are an increasingly recognized cause of hypoglycemia. Proinsulin levels must always be included as part of the workup of hypoglycemia in an adult.
目的
报告一例胃旁路术（RYGB）后复发性低血糖病例，其病因被确定为以胰岛素原为主的胰腺神经内分泌肿瘤（胰岛素原瘤）。
方法
本文呈现了一个病例报告，并对相关文献进行简要讨论和回顾。
结果
该患者为一名62岁女性，在接受RYGB手术11年后出现症状性低血糖。初步检查显示胰岛素水平低而胰岛素原水平升高。72小时禁食试验证实存在由胰腺神经内分泌肿瘤（PNET）继发的胰岛素原诱导的低血糖。她接受了远端胰腺切除术加脾切除术，成功切除了PNET肿瘤，症状得以缓解。
结论
RYGB手术后低血糖是一种公认的综合征。虽然其病因有多种，但在该人群的鉴别诊断中应考虑PNET（包括胰岛素原瘤）。胰岛素原瘤是一种越来越被认识到的低血糖病因。在成人低血糖检查中，胰岛素原水平必须始终作为检查的一部分。
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