Preston Christopher A, Sachithanandan Nirupa, Sim Ie-Wen, van Heerden Jon, Farrell Stephen
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.
Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria 3021, Australia.
JCEM Case Rep. 2024 Jan 8;2(2):luad168. doi: 10.1210/jcemcr/luad168. eCollection 2024 Feb.
A case of recurrent insulinoma spanning 4 decades is described. Following a delayed diagnosis, hyperinsulinemic hypoglycemia was confirmed in a 24-year-old woman during early pregnancy. Initial surgery, culminating in subtotal pancreatectomy, was noncurative. A 1-cm insulinoma was subsequently resected from the head of the pancreas postpartum, with postoperative resolution of hypoglycemia. However, 32 years later, the patient experienced a recurrence of hypoglycemic symptoms. Eventually, a subcentimeter extrapancreatic lesion was identified anterior to the pancreatic head on gallium-68 DOTA-Exendin-4 positron emission tomography/computed tomography. In 2022, a third operation was performed, with excision of a 4 × 3 mm tumor adjacent to the pancreatic head, and histology confirming insulinoma. She was again cured of symptoms.
本文描述了一例病程长达40年的复发性胰岛素瘤病例。在延迟诊断后，一名24岁的孕妇在孕早期被确诊为高胰岛素血症性低血糖。初次手术最终行胰腺次全切除术，但未治愈。产后从胰头切除了一个1厘米的胰岛素瘤，术后低血糖症状消失。然而，32年后，患者低血糖症状复发。最终，在68Ga DOTA-Exendin-4正电子发射断层扫描/计算机断层扫描中，在胰头前方发现了一个小于1厘米的胰腺外病变。2022年，患者接受了第三次手术，切除了胰头附近一个4×3毫米的肿瘤，组织学检查证实为胰岛素瘤。她的症状再次得到治愈。
