Insulinoma and pregnancy: anesthesia and perioperative management

Braga, Angélica de Fátima de Assunção; Braga, Franklin Sarmento da Silva; Zen, José Hélio; Brandão, Maria José Nascimento; Marcondes, Giancarlo; Barbosa, Thales Daniel Alves

doi:10.1016/j.bjane.2016.06.003

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…Case 1 from series of Diaz et al was excluded as the time of diagnosis (4 years post-partum) is uncertainly associated with pregnancy. 9 ClinicalTrials.gov provided 22 items. Five out of those 22 were eligible for insulinoma but none of the trials included pregnant or breastfeeding women.…”

Section: Methodsmentioning

confidence: 99%

Insulinoma in pregnancy (a case presentation and systematic review of the literature)

et al. 2021

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Insulinomas are rare, benign and functional tumors that coincidentally may become overt during pregnancy or in the post-partum period. As the general symptoms of a pregnancy might cover the clinical presentation, diagnosing remains challenging. We present one additional case of a post-partum insulinoma, combined with a systematic review of the literature to sum up relevant details in diagnosis and treatment. A systematic request of Pubmed/Medline was conducted using the following terms: “insulinoma AND pregnancy” and “insulinoma” for a second request of ClinicalTrials.gov. All publications concerning pregnant or post-partum women with insulinoma were included. Thirty-six cases could be identified for analysis. Each publication was reviewed for demographic, diagnostic and therapeutic data. The most frequent clinical signs were unconsciousness and neurological symptoms. 64.9% were diagnosed during early pregnancy and 35.1% post-partum. 91.9% underwent surgery with a third resected during pregnancy without severe influence on fetal or maternal outcome. Three patients died of metastatic disease or misdiagnosing, two of them miscarried. Insulinoma in pregnancy is rare but should be considered in case of unclear hyperinsulinemic hypoglycemia. Surgery can be performed during the second trimester or post-partum with promising outcome.

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Section: Methodsmentioning

confidence: 99%

Insulinoma in pregnancy (a case presentation and systematic review of the literature)

et al. 2021

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“…Kondisi hiperglikemia pascaoperasi memerlukan pemberian insulin untuk menjaga gula darah tidak terlalu tinggi. 2,6 Berdasarkan beberapa laporan kasus, teknik pembiusan yang disarankan adalah dengan anestesi umum yang dikombinasi dengan regional epidural. Anestesi regional dengan epidural dapat digunakan sebagai analgetik pascaoperasi yang optimal.…”

Section: Laporan Kasusunclassified

“…Pemberian analgetik yang optimal akan mempercepat mobilisasi pasien. 4,5,6 Penggunaan obat-obat antiepilepsi sesegera mungkin diteruskan pascaoperasi. Hindari interupsi penggunaan obat.…”

Section: Laporan Kasusunclassified

Manajemen Perioperatif Pasien Insulinoma Dengan Komorbid Epilepsi

Adiyanto,

Kurniawaty,

Pambudi

2020

jka

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Insulinoma adalah golongan tumor jinak neuroendokrin fungsional pada organ pankreas yang mengakibatkan sekresi insulin yang berlebihan dan menghasilkan manifestasi klinis akibat episode hipoglikemia. Sedangkan epilepsi adalah manifestasi gangguan otak yang memiliki gejala klinis yang bervariasi disebabkan oleh pelepasan impuls listrik yang berlebihan pada otak. Seorang laki-laki berusia 50 tahun dengan insulinoma direncanakan untuk tindakan laparoskopi reseksi tumor. Pasien juga memiliki komorbid epilepsi. Teknik anestesi yang digunakan adalah anestesi umum dengan intubasi. Hipoglikemia adalah masalah yang dapat terjadi pada periode preoperasi dan intraoperasi sehingga dilakukan pemantauan kadar glukosa setiap 30 menit. Konsiderasi anestesi pada pasien ini adalah mencegah terjadinya hipoglikemia pada periode praoperasi maupun intraoperasi, hindari penggunaan anti agen anestesi yang bersifat prokonvulsan dikarenakan pasien memiliki komorbid epilepsi.

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“…The therapeutic management is relatively convenient considering the less aggressive behaviour of the tumour: maintaining and monitoring reasonable levels of blood glucose through reduced meal portions frequently administrated, glucose perfusions until the foetus is mature enough for birth, followed by resectional surgery (92,93).…”

Section: Therapeutic Managementmentioning

confidence: 99%

Pancreatic Neuroendocrine Tumour in Pregnancy - Diagnosis and Treatment Management

Predescu¹

2019

chr

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Diagnosis and Treatment Management Chirurgia, 114 (5), 2019 www.revistachirurgia.ro 551 investigaţii sau alteia revenind trimestrului de graviditate. Precauţia legată de "compromiterea" fetală în indicarea unei explorări invazive (imagistice, endoscopice, etc) întârzie de asemenea diagnosticul. Caracterul puţin agresiv, mai de curând cu potenţial benign face ca prognosticul insulinoamelor să fie în general unul favorabil iar posibilităţile terapeutice uşor de administrat şi controlat la gravide. Tratamentul medical se adresează pacientelor atunci când există diagnostic pozitiv dar nu putut identifica topografia insulinomului, când simptomatologia este uşor controlată prin terapie conservatoare până când se obţine o vârstă convenabilă a fătului fie imediat postpartum, la gravidele care refuză intervenţia chirurgicală, fie în stadiul metastatic al insulinomului malign. Tratamentul chirurgical rămâne cu adevărat singura modalitate de rezolvare terapeutică dar, cel mai adesea, sub forma unei chirurgii programate, de regulă post-partum, sau dacă situaţia "forţează" indicaţia, cât mai târziu după o vârstă fetală convenabilă (după 28 săptămâni). Cuvinte cheie: neoplazia neuroendocrinã pancreaticã, sarcinã, managementul de diagnostic şi tratament

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Insulinoma and pregnancy: anesthesia and perioperative management

Cited by 3 publications

References 15 publications

Insulinoma in pregnancy (a case presentation and systematic review of the literature)

Insulinoma in pregnancy (a case presentation and systematic review of the literature)

Manajemen Perioperatif Pasien Insulinoma Dengan Komorbid Epilepsi

Pancreatic Neuroendocrine Tumour in Pregnancy - Diagnosis and Treatment Management

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