Insulinomas do pâncreas: diagnóstico e tratamento

Apodaca-Torrez, Franz Robert; Triviño, Tarcísio; Lobo, Edson José; Goldenberg, Alberto; Figueira, Ana Rita

doi:10.1590/s0004-28032003000200003

Cited by 11 publications

(38 citation statements)

References 36 publications

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“…Recommendations on the preoperative investigation, better surgical techniques and prognostic factors are still reason of discussion. Of the neuroendocrine tumors of pancreas insulinoma is the most common, representing 70% of them 1,3,8 . In this series, were more prevalent in females (68%), in accordance with the data of large studies 1,6,8 .…”

Section: Discussionmentioning

confidence: 99%

“…It was first described by Nicholls on 1902 7 and by Wilder in 1927 15 , but there was better understanding of the disease from the studies of Whipple and Frantz in 1935 14 . Although rare, is the most common pancreatic endocrine tumor, with about four cases per million people 1 . It's landmark is the triad of Whipple, characterized by symptoms of hypoglycemia, low blood glucose (40-50 mg / dL) and relief of symptoms with the intravenous administration of glucose.…”

Section: Introductionmentioning

confidence: 99%

“…The preferred treatment is surgery, performed in a conventional or laparoscopic manner, and with or without additional method for intraoperative location of the lesion 1,9,11 . The present study aims to analyze the clinical, epidemiological, pathological and surgical patients treated in the last decade in two surgical services.…”

Section: Introductionmentioning

confidence: 99%

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Tratamento cirúrgico dos insulinomas do pâncreas

Bonato

Coelho

Petruzzielo

et al. 2012

ABCD, arq. bras. cir. dig.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tratamento cirúrgico dos insulinomas do pâncreas

Bonato

Coelho

Petruzzielo

et al. 2012

ABCD, arq. bras. cir. dig.

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“…(43), que obtiveram sucesso em 70% dos casos. Finalmente, a ultrassonografia intraoperatória tem sido considerada como o método mais sensível e específico, localizando a lesão com índices superiores a 95%, principalmente combinada à palpação (3,38,44). Em nosso estudo, a ultrassonografia intraoperatória foi capaz de localizar o insulinoma em 100% dos casos (Tabela 4).…”

Section: Em Nosso Estudo Foram Avaliados Os Aspectos Diagnós-ticos (Cunclassified

“…O estudo imuno-histoquímico dos insulinomas permite caracterizar melhor essas neoplasias, evidenciando que a maioria dos tumores endócrinos do pâncreas produz mais de um hormônio (44,50,51). Na série de Apodaca-Torrez e cols.…”

Section: Em Nosso Estudo Foram Avaliados Os Aspectos Diagnós-ticos (Cunclassified

Hiperinsulinismo endógeno: revisão e seguimento de 24 casos

Felício

Martins

Semer

et al. 2012

Arq Bras Endocrinol Metab

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SUMÁRIOEm decorrência do hiperinsulinismo endógeno (HHE), a hipoglicemia é diagnosticada em um indivíduo sintomático com níveis baixos de glicose plasmática, concomitante a valores elevados de insulina plasmática e peptídeo-C. Entre as causas de HHE, estão as doenças das células-b das ilhotas pancreáticas, o uso de secretagogos e a hipoglicemia autoimune. Neste artigo de revisão, estudamos 24 pacientes com hipoglicemia decorrente de hiperinsulinismo endógeno com a finalidade de descrever os aspectos de diagnóstico e tratamento. Nosso estudo mostrou que, após a realização do teste de jejum de 12h (minijejum) em três dias diferentes, todos os pacientes preencheram os critérios diagnósticos de HHE. Adicionalmente, encontramos que 11 dos 12 pacientes (91,7%) que realizaram o teste do glucagon apresentaram níveis de glicose no tempo 120 minutos menores que 50 mg/dL e inferiores ao valor basal. O teste do minijejum (3 amostras) e o teste do glucagon poderiam ser úteis para evitar a realização do jejum prolongado no diagnóstico do hiperinsulinismo endógeno. Arq Bras Endocrinol Metab. 2012;56(2):83-95 Descritores Hiperinsulinismo; insulinoma; hipoglicemia; pâncreas SUMMARY Hypoglycemia due to endogenous hyperinsulinism (EH) is diagnosed in a symptomatic patient with low levels of plasma glucose concomitant with elevated plasma insulin and C-peptide. Causes of EH are pancreatic islet-cells disease, use of insulin secretagogues, and autoimmune hypoglycemia. In this review, the authors studied 24 patients with hypoglycemia due to endogenous hyperinsulinism in order to describe aspects of diagnosis and treatment. Our study demonstrated that after 12 hours of fasting (mini-fasting test; at least three samples), all patients presented the diagnostic criteria for EH. Additionally, we found that 11 of 12 patients (91.7%) who underwent glucagon test achieved glucose levels less than 50 mg/dL and below baseline after 120 minutes. Mini-fasting (3 samples) and glucagon test may be useful to prevent prolonged fasting test to clarify the diagnosis of endogenous hyperinsulinism. Arq Bras Endocrinol Metab. 2012;56 (2) INTRODUÇÃOA glicose é um substrato metabólico fundamental para o cérebro, sendo a prevenção e a correção da hipoglicemia fundamentais para a manutenção da vida (1). A hipoglicemia pode ser dividida em pós-prandial (até 5h após a refeição) e de jejum e seu diagnóstico se baseia na presença da tríade de Whipple (glicose plasmática baixa, sintomas compatíveis com hipoglicemia e melhora dos sintomas após o aumento nas concentrações de glicose), cuja presença deve impelir à análise de suas potenciais causas, sendo essa investigação fortemente recomendada (2,3). Entretanto, o diagnóstico é praticamente inequívoco mesmo na ausên cia de sintomas se os valores de glicose plasmática estiverem abaixo de: 50 mg/dL na idade adulta e na adolescência (4,5), 40 mg/dL na criança pré-púbere (6), 30 mg/dL no neonato a termo e 20 mg/dL no neonato prematuro e/ou pequeno para a idade gestacional (7). EnCorrespondência para:

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A novel diagnostic model for insulinoma

et al. 2022

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The aim is to describe a simple and feasible model for the diagnosis of insulinoma. This retrospective study enrolled 37 patients with insulinoma and 44 patients with hypoglycemia not due to insulinoma at the First Affiliated Hospital of Guangxi Medical University. General demographic and clinical characteristics; hemoglobin A1c (HbA1c), insulin and C-peptide concentrations; and the results of 2-h oral glucose tolerance tests (OGTT) were recorded, and a logistic regression model predictive of insulinoma was determined. Body mass index (BMI), HbA1c concentration, 0-h C-peptide concentration, and 0-h and 1-h plasma glucose concentrations (P < 0.05 each) were independently associated with insulinoma. A regression prediction model was established through multivariate logistics regression analysis: Logit p = 7.399+(0.310 × BMI) − (1.851 × HbA1c) − (1.467 × 0-h plasma glucose) + (1.963 × 0-h C-peptide) − (0.612 × 1-h plasma glucose). Using this index to draw a receiver operating characteristic (ROC) curve, the area under the curve (AUC) was found to be 0.957. The optimal cut-off value was − 0.17, which had a sensitivity of 89.2% and a specificity of 86.4%. Logit P ≥ − 0.17 can be used as a diagnostic marker for predicting insulinoma in patients with hypoglycemia.

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Insulinomas do pâncreas: diagnóstico e tratamento

Abstract: All patients presented satisfactory outcome and remained asymptomatic with normal glicemia levels.

Cited by 11 publications

References 36 publications

Tratamento cirúrgico dos insulinomas do pâncreas

Tratamento cirúrgico dos insulinomas do pâncreas

Hiperinsulinismo endógeno: revisão e seguimento de 24 casos

A novel diagnostic model for insulinoma

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