Chatterjee Subhankar, Bhattacharjee Rana, Ghosh Ritwik, Chakraborty Partha P, Sinha Anirban, Maiti Animesh
Department of Endocrinology and Metabolism, Medical College and Hospital, Kolkata, West Bengal, India.
Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India.
Indian J Endocrinol Metab. 2024 Nov-Dec;28(6):554-561. doi: 10.4103/ijem.ijem_154_24. Epub 2024 Sep 18.
Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes.
We conducted a literature search using PubMed and Google Scholar, employing various combinations of the following terms: 'insulinoma', 'diabetes', 'nesidioblastosis', 'endogenous hyperinsulinism', 'hypoglycaemia', and 'hyperglycaemia' (from January 1900 to January 30, 2024). Exclusion criteria included non-English publications, duplicate articles, reports lacking sufficient data, cases of endogenous hyperinsulinemic hypoglycaemia other than insulinoma, and inaccessible articles. Statistical analysis was performed using appropriate methods.
Sixty patients were considered for the final analysis. Mean age was 61 ± 15 years (range: 17-96 years) with a slight female preponderance; 88.3% had type-2 diabetes with a median duration of 8 years. The median delay in diagnosis of insulinoma was 6 months. Median blood glucose varied from 30.5 mg/dL to 235 mg/dL, with a mean HbA1c of 5.6 ± 1.3% (range: 2.9%-8.2%). Critical sampling data were available in 75% of cases. The median size of the insulinoma was 2 cm. Furthermore, 5.2% of insulinomas were extra-pancreatic. Among pancreatic insulinomas, 14.5% were multi-focal. One-third of cases were malignant. Surgical resection was done in 70.9% of cases, while 40% received drug therapy and 12.7% received both, with 20.7% overall mortality. Malignant insulinoma ( = 0.007), micro-angiopathic ( = 0.018) and macro-angiopathic complications ( = 0.039), and other co-morbidities ( = 0.009) were associated with unfavourable prognosis, while being overweight and obese ( = 0.020) at presentation was associated with favourable prognosis.
This first systematic review provides insights into the uniqueness of insulinoma in diabetes.
胰岛素瘤与糖尿病并存的矛盾情况极为罕见。尽管有一些病例报告涉及这种关联，但一直缺乏阐明这种关系的全面研究。我们对已发表的糖尿病患者胰岛素瘤病例进行了系统评价。
我们使用PubMed和谷歌学术进行文献检索，采用以下术语的各种组合：“胰岛素瘤”、“糖尿病”、“胰岛细胞增殖症”、“内源性高胰岛素血症”、“低血糖症”和“高血糖症”（从1900年1月至2024年1月30日）。排除标准包括非英文出版物、重复文章、缺乏足够数据的报告、除胰岛素瘤外的内源性高胰岛素血症低血糖症病例以及无法获取的文章。使用适当的方法进行统计分析。
60例患者纳入最终分析。平均年龄为61±15岁（范围：17 - 96岁），女性略占优势；88.3%患有2型糖尿病，中位病程为8年。胰岛素瘤诊断的中位延迟时间为6个月。中位血糖水平在30.5mg/dL至235mg/dL之间，平均糖化血红蛋白为5.6±1.3%（范围：2.9% - 8.2%）。75%的病例有关键采样数据。胰岛素瘤的中位大小为2cm。此外，5.2%的胰岛素瘤位于胰腺外。在胰腺胰岛素瘤中，14.5%为多灶性。三分之一的病例为恶性。70.9%的病例进行了手术切除，40%接受了药物治疗，12.7%两者都接受了，总死亡率为20.7%。恶性胰岛素瘤（P = 0.007）、微血管病变（P = 0.018）和大血管病变并发症（P = 0.039）以及其他合并症（P = 0.009）与不良预后相关，而就诊时超重和肥胖（P = 0.020）与良好预后相关。
这项首次系统评价提供了对糖尿病中胰岛素瘤独特性的见解。
