Gupta Setu, Goyal Alpesh, Kandasamy Devasenathipathy, Agarwal Shipra, Damle Nishikant, Pal Sujoy, Tandon Nikhil, Jyotsna Viveka P
Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Indian J Endocrinol Metab. 2024 Jul-Aug;28(4):363-369. doi: 10.4103/ijem.ijem_87_24. Epub 2024 Aug 28.
Endogenous hyperinsulinaemic hypoglycaemia (EHH) is characterized by inappropriate insulin secretion from pancreatic beta cells despite low blood glucose concentrations. We aimed to evaluate the secular changes in presentation and management of EHH due to insulinoma/non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) at our centre.
This was a single-centre ambispective study (2014-2022). The clinical, biochemical, hormonal and radiological parameters (n = 63) collected as part of this study were compared with our earlier studies (1992-2005, n = 31; and 2006-2013, n = 35) and with other centres across the world.
A total of 63 patients (39 males) with a preoperative diagnosis of EHH (insulinoma, n = 58; and NIPHS, n = 5) and a mean age of 40.7 years were studied. The mean lag time from the onset of symptoms to diagnosis decreased from 4.6 years during the first study period to 1.9 years during this study period. However, the majority presented with fasting hypoglycaemia of 98.4%, and both fasting and postprandial hypoglycaemia of 32%. Exclusive postprandial hypoglycaemia was present in 1.7% of insulinoma. A histopathological diagnosis of insulinoma was made in 52 patients and nesidioblastosis in two patients. Intraoperative ultrasonography (IOUS) and intraoperative palpation (IOP) yielded 100% sensitivity, while endoscopic ultrasonography (EUS) and 68Ga-DOTA-Exendin-4 positron emission tomography/computed tomography (PET/CT) yielded sensitivity of 86% and 85%, respectively, for localizing insulinoma. Resolution of hypoglycaemia was noted in 53 of 57 (93%) patients who underwent surgery with a preoperative diagnosis of insulinoma.
We observed a trend towards earlier diagnosis of EHH, increased patient numbers and availability of nuclear imaging techniques for preoperative localization in the last decade compared to earlier.
内源性高胰岛素血症性低血糖症（EHH）的特征是尽管血糖浓度较低，但胰腺β细胞仍分泌不适当的胰岛素。我们旨在评估我院因胰岛素瘤/非胰岛素瘤胰源性低血糖综合征（NIPHS）导致的EHH在临床表现和治疗方面的长期变化。
这是一项单中心回顾性研究（2014 - 2022年）。将本研究收集的临床、生化、激素和放射学参数（n = 63）与我们早期的研究（1992 - 2005年，n = 31；2006 - 2013年，n = 35）以及世界其他中心进行比较。
共研究了63例术前诊断为EHH的患者（39例男性），平均年龄40.7岁（胰岛素瘤58例，NIPHS 5例）。从症状出现到诊断的平均延迟时间从第一个研究期间的4.6年降至本研究期间的1.9年。然而，大多数患者表现为空腹低血糖（98.4%），同时存在空腹和餐后低血糖的患者占32%。仅餐后低血糖出现在1.7%的胰岛素瘤患者中。52例患者诊断为胰岛素瘤，2例诊断为胰岛细胞增殖症。术中超声检查（IOUS）和术中触诊（IOP）的敏感性为100%，而内镜超声检查（EUS）和68Ga - DOTA - Exendin - 4正电子发射断层扫描/计算机断层扫描（PET/CT）对胰岛素瘤定位的敏感性分别为86%和85%。术前诊断为胰岛素瘤并接受手术的57例患者中有53例（93%）低血糖症状得到缓解。
我们观察到与早期相比，在过去十年中EHH的诊断有提前的趋势，患者数量增加，术前定位的核成像技术可用性提高。
