Linch Forrest, Thompson Scott, Fleming Chad, Vella Adrian, Andrews James
Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.
J Endocr Soc. 2021 Oct 7;5(12):bvab149. doi: 10.1210/jendso/bvab149. eCollection 2021 Dec 1.
Insulinoma is a pancreatic neuroendocrine tumor that causes hyperinsulinemic hypoglycemia. Symptomatic hypoglycemia related to hepatic insulinoma metastases may be addressed with liver-directed therapies such as hepatic artery embolization.
This work aimed to determine the safety and effectiveness of bland hepatic artery embolization (HAE) for palliation of symptomatic hypoglycemia in patients with hepatic insulinoma metastases refractory to medical management.
An institutional review board-approved retrospective review was undertaken of all patients with a tissue (n = 18) or imaging (n = 2) diagnosis of hepatic insulinoma metastases and symptomatic hyperinsulinemic hypoglycemia refractory to medical management who underwent bland HAE at a single center between January 1, 1998 and November 1, 2020. Twenty patients (10 women, 10 men; mean age, 56 years; range, 18-84 years) were identified who individually underwent 1 (n = 7), 2 (n = 5), 3 (n = 5), 4 (n = 2), or 5 (n = 1) HAEs, for an overall total of 45 HAEs. Post-HAE hypoglycemia recurrence was defined as onset of adrenergic symptoms (eg, sweating, weakness, tremor), neuroglycopenic symptoms (eg, confusion, loss of consciousness), and/or documented serum glucose of less than 50 mg/dL, in the absence of an alternative explanation. Median time to first hypoglycemia recurrence, hypoglycemia-free survival (HFS), and overall survival (OS) were calculated using Kaplan-Meier method.
Before HAE, all patients experienced adrenergic or neuroglycopenic symptoms alleviated by glucose intake, and 60% (n = 12) of patients had documented serum glucose of less than 50 mg/dL within 1 week of the first treatment. Median post-HAE follow-up was 9.4 months (mean, 26 months; range, 0.1-190 months). Postprocedural hypoglycemic symptom relief after the first HAE was reported in 100% (n = 20) of patients before discharge or at follow-up. Post-HAE hypoglycemia recurrence occurred in 60% (n = 12) of patients with a median time to first hypoglycemia recurrence of 2 months (mean, 14 months; range, 0.2-60 months). After the first HAE, median HFS was 14.5 months, and median OS was 16 months. One patient experienced labile postprocedure blood glucose levels requiring intensive care unit admission for intravenous dextrose. Otherwise, no major procedure-related complications occurred.
Bland HAE is a safe, effective, and repeatable procedure for palliation of symptomatic hypoglycemia in patients with hepatic insulinoma metastases refractory to medical management.
胰岛素瘤是一种胰腺神经内分泌肿瘤，可导致高胰岛素血症性低血糖。与肝胰岛素瘤转移相关的症状性低血糖可通过肝动脉栓塞等肝脏定向治疗来处理。
本研究旨在确定单纯肝动脉栓塞术（HAE）对内科治疗无效的肝胰岛素瘤转移患者缓解症状性低血糖的安全性和有效性。
对1998年1月1日至2020年11月1日在单一中心接受单纯HAE治疗的所有组织学诊断（n = 18）或影像学诊断（n = 2）为肝胰岛素瘤转移且内科治疗无效的症状性高胰岛素血症性低血糖患者进行了一项经机构审查委员会批准的回顾性研究。确定了20例患者（10例女性，10例男性；平均年龄56岁；范围18 - 84岁），他们分别接受了1次（n = 7）、2次（n = 5）、3次（n = 5）、4次（n = 2）或5次（n = 1）HAE，总共进行了45次HAE。HAE后低血糖复发定义为出现肾上腺素能症状（如出汗、虚弱、震颤）、神经低血糖症状（如意识模糊、意识丧失）和/或记录的血清葡萄糖低于50 mg/dL，且无其他解释。使用Kaplan-Meier方法计算首次低血糖复发的中位时间、无低血糖生存期（HFS）和总生存期（OS）。
在HAE之前，所有患者的肾上腺素能或神经低血糖症状通过摄入葡萄糖得到缓解，60%（n = 12）的患者在首次治疗后1周内记录的血清葡萄糖低于50 mg/dL。HAE后的中位随访时间为9.4个月（平均26个月；范围0.1 - 190个月）。100%（n = 20）的患者在出院前或随访时报告首次HAE后程序性低血糖症状缓解。60%（n = 12）的患者发生了HAE后低血糖复发，首次低血糖复发的中位时间为2个月（平均14个月；范围0.2 - 60个月）。首次HAE后，中位HFS为14.5个月，中位OS为16个月。1例患者术后血糖水平不稳定，需要入住重症监护病房接受静脉输注葡萄糖治疗。除此之外，未发生重大的与手术相关的并发症。
单纯HAE是一种安全、有效且可重复的方法，用于缓解内科治疗无效的肝胰岛素瘤转移患者的症状性低血糖。
