2Городская клиническая больница №5 Департамента здравоохранения г. Москвы, Россия 3 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия Распространенность инсулином составляет 1-3 случая на один миллион населения в год, из которых в 4-14% случаев опухоль является злокачественной. Увеличение массы тела является одним из проявлений заболевания, нередко приводя к морбидному ожирению с показаниями для оперативного лечения. Представленный клинический случай, демонстрирует успешное лечение пациента с низким функциональным статусом на фоне злокачественной инсулиномы с манифестацией рефрактерного гипогликемического синдрома после проведения билиопанкреатического шунтирования с продольной резекцией желудка по поводу морбидного ожирения.КЛЮЧЕВЫЕ СЛОВА: гипогликемический синдром, злокачественная инсулинома, морбидное ожирение, бариатрическая хирургия, билиопанкреатическое шунтирование, клинический случай.The prevalence of insulinomas is 1-3 cases per million population per year of which 4-14% tumor is malignant. Weight gain is one of the symptoms of the disease, often resulting in morbid obesity with indications for surgical treatment. The presented clinical case demonstrates the successful treatment of malignant insulinoma with the manifestation of hypoglycemic syndrome after carrying out biliopancreatic bypass with longitudinal gastrectomy for morbid obesity. TO CITE THIS ARTICLE:Maloletkina ES, Gurova OYu, Fadeev VV, Egorov VI, Petrov RV, Beltsevich DG. Case of insulinoma detected in a patient after bariatric operation for morbid obesity. Obesity and metabolism. 2019;16(1):74-80.
In recent years, the options in treatment of diabetes mellitus type 2 have substantially expanded (currently more than 40 molecules are approved), however, the number of patients with decompensation of diabetes for the period from 2003 to 2014 remains unchanged. In clinical guidelines injecting drugs are given the final role as the most effective drugs. However in clinical trials injecting drugs showed a lower adherence compared to oral drugs. Currently injectable glucose lowering drugs include not only insulin but also analogues of glucagon-like peptide-1 (aGLP-1). However, majority of studies of treatment compliance in type 2 diabetes mellitus considered only insulin. Reasons of low compliance are: 1) offering comprehensive programmes for education, monitoring and patient support by primary care physicians; 2) addressing cost and availability issues; 3) prescribing current insulin, also in combination with GLP-1 agonists; 4) use of more simple and convenient devices for injecting insulin.
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