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ISSN 2007-8013 (Print)
Órgano oficial de la Universidad Autónoma de Sinaloa

2022, Number 1

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Rev Med UAS 2022; 12 (1)

Ninety-one-year-old female with severe hypoglycemic events secondary to an insulinoma: A case report and review of literature

Navarro-Chavez H, Garza-Vega J, Segura-Ibarra V, Frausto-Alejos MG, Flores-Villalba E

Language: English
References: 19
Page: 49-55
PDF size: 181.16 Kb.


ABSTRACT

Neuroendocrine tumors are a vast group of neoplasms. Insulinomas are the most frequent functioning pancreatic neuroendocrine tumors. Therapeutic gold standard is surgery without which most patients have a fatal outcome due to hypoglycemia. Herein we report a case of a 91-year-old female, with a 3 month history of asthenia and adynamia, which progressed to several neuroglycopenic events, leading to hospitalization. An abdominal CT-scan reported 1.8 x 1.4 cm pancreatic tumor. Labs reported proinsulin 40.5 pM/L. Laparoscopic enucleation was performed. 3 months later she presented a pancreatic pseudocyst treated successfully by endoscopy. Insulinomas, are considered to have low-malignant potential, it is a rare endocrinal tumor and there is minimal mention about a consensus for optimal surgical treatment. Insulinoma remains an exclusion diagnosis after analyzing other differentials. Correct utilization of pre-operative imaging is critical in pre-surgical planning to choose the appropriate surgery.


REFERENCES

  1. Yao JC, Hassan M, Phan A, Dagohoy C,Leary C, Mares JE, et al. One hundred yearsafter "carcinoid": epidemiology of and prognosticfactors for neuroendocrine tumors in35,825 cases in the United States. J Clin Oncol. 2008 Jun 20;26(18):3063-7

  2. doi:10.1200/JCO.2007.15.4377.2. Service FJ, McMahon MM, O'Brien PC, BallardDJ. Functioning insulinoma--incidence,recurrence, and long-term survival of patients:a 60-year study. Mayo Clin Proc. 1991Jul;66(7):711-9. doi: 10.1016/s0025-6196(12)62083-7.

  3. Mathur A, Gorden P, Libutti SK. Insulinoma.Surg Clin North Am. 2009 Oct;89(5):1105–21.

  4. Halfdanarson TR, Rabe KG, Rubin J, PetersenGM. Pancreatic neuroendocrine tumors(PNETs): incidence, prognosis and recenttrend toward improved survival. AnnOncol. 2008 Oct;19(10):1727-33. doi:10.1093/annonc/mdn351.

  5. Agha RA, Borrelli MR, Farwana R, Koshy K,Fowler AJ, Orgill DP; SCARE Group. TheSCARE 2018 statement: Updating consensusSurgical CAse REport (SCARE) guidelines.Int J Surg. 2018 Dec;60:132-136. doi:10.1016/j.ijsu.2018.10.028.

  6. Pearse AG. The APUD concept and hormoneproduction. Clin Endocrinol Metab.1980; 9:211–22.

  7. Mahdi M, Almehman B, Nassan S, BinyahibS. Pancreatic insulinoma causing hypoglycemicepisodes. J Pediatr Surg Case Rep2020 Jun. doi: 10.1016/j.epsc.2020.101466

  8. Brandi ML, Gagel RF, Angeli A, BilezikianJP, Beck-Peccoz P, Bordi C, et al. Guidelinesfor diagnosis and therapy of MEN type1 and type 2. J Clin Endocrinol Metab. 2001Dec;86(12):5658-71. doi:10.1210/jcem.86.12.8070.

  9. Triponez F, Dosseh D, Goudet P, CougardP, Bauters C, Murat A, et al. Epidemiologydata on 108 MEN 1 patients from the GTEwith isolated nonfunctioning tumors of thepancreas. Ann Surg 2006 Feb;243(2):265-72. doi:

  10. 10.1097/01.sla.0000197715.96762.68.10. Whipple AO, Frantz VK. Adenoma of isletcells with hyperinsulinism: a review. AnnSurg 1935 Jun;101(6):1299-335. doi:10.1097/00000658-193506000-00001.

  11. Harrington MG, McGeorge AP, BallantyneJP, Beastall G. A prospective survey for insulinomasin a neurology department. Lancet.1983 May 14;1(8333):1094-5. doi:10.1016/s0140-6736(83)91923-2.

  12. Guettier JM, Lungu A, Goodling A, CochranC, Gorden P. The role of proinsulin and insulinin the diagnosis of insulinoma: a criticalevaluation of the Endocrine Society clinicalpractice guideline. J Clin Endocrinol Metab2013 Dec;98(12):4752-8. doi:10.1210/jc.2013-2182.

  13. Khashab MA, Yong E, Lennon AM, Shin EJ,Amateau S, Hruban RH, et al. EUS is still superiorto multidetector computerized tomographyfor detection of pancreatic neuroendocrinetumors. Gastrointest Endosc. 2011Apr;73(4):691-6. doi:10.1016/j.gie.2010.08.030.

  14. Finlayson E, Clark OH. Surgical treatment ofinsulinomas. Surgical Clin North Am. 2004;84:775–85.

  15. Câmara-de-Souza AB, Toyoshima MTK,Giannella ML, Freire DS, Camacho CP, LourençoDM, et al. Insulinoma: A retrospectivestudy analyzing the differences between benignand malignant tumors. Pancreatology.2018 Apr;18(3):298–303.

  16. Sosa JA, Bowman HM, Gordon TA, BassEB, Yeo CJ, Lillemoe KD, et al. Importanceof hospital volume in the overall managementof pancreatic cancer. Ann Surg. 1998Sep;228(3):429-38. doi: 10.1097/00000658-199809000-00016.

  17. Howell DA, Elton E, Parsons WG. Endoscopicmanagement of pseudocysts of thepancreas. Gastrointest Endosc Clin N Am.1998 Jan;8(1):143-62.

  18. Cherkasov M, Sitnikov V, Sarkisyan B,Degtirev O, Turbin M, Yakuba A. Laparoscopyversus laparotomy in management ofabdominal trauma. Surg Endosc. 2008Jan;22(1):228-31. doi: 10.1007/s00464-007-9550-z.

  19. Hochwald SN, Zee S, Conlon KC, ColleoniR, Louie O, Brennan MF, et al. Prognosticfactors in pancreatic endocrine neoplasms:an analysis of 136 cases with a proposal forlow-grade and intermediate-grade groups. JClin Oncol. 2002 Jun 1;20(11):2633-42.doi: 10.1200/JCO.2002.10.030.




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