Polineuropatia hipoglicêmica: registro de caso com insulinoma

Abstract

RESUMO -Os autores registram o caso de jovem do sexo masculino que desenvolveu polineuropatia sensitivo-motora, com grande amiotrofia das mãos, no curso de crises de. hipoglicemia, provocadas por provável insulinoma. A eletroneuromiografia revelou predominância de alterações axonais. O nervo sural, estudado à microscopia óptica e eletrônica, mostrou perda axonal de fibras mielínicas de grande calibre e de fibras amielínicas. Considerações sobre a etiopatogenia desta síndrome são feitas, parecendo ser devida a hipoglicemia e não a excesso de insulina.Hypoglycemic neuropathy: a case report in association with an insulinoma.SUMMARY -A case of a young man who presented symptoms and clinical signs of polineuropathy that occurred in connection with recurrent hypoglycemic episodes is reported. The hypoglycemia was probably caused by a pancreatic islet tumor. There were, symmetric weakness and wasting of hands and feet, absent tendon reflexes and 'glove and stocking' loss of sensation.Electromyographic studies showed denervation potentials with slight reduction of nerve conduction velocities. Sural nerve biopsy studied by optic and electronic microscopy showed axonal degeneration without signs of demyelination or remyellnation. There are only 30 similar cases reported in the literature.According to experimental findings, the authors believe that glucopenia is the mechanism responsible for the development of the neuropathy, and that at present time there is no evidence for a direct insulin effect. São frequentes as alterações do sistema nervoso central (SNC) provocadas por hipoglicemia devida à presença de insulinoma.Entretanto, o acometimento do sistema nervoso periférico raramente tem sido relatado na vigência da queda da glicose sanguínea.As A observação de paciente jovem do sexo masculino que apresentou fraqueza e atrofia muscular distai com distúrbios sensitivos e arreflexia profunda generalizada, devido a crises hipoglicêmicas provocadas por provável tumor das ilhotas de Langerhans, levou ao presente relato.

Sensorimotor Polyneuropathy in a Diabetic Patient After Rapid Overcorrection of Chronic Hyperglycemia

“… 16 Considering the neuropathy described by the patient in our case was predominantly motor, with only mild paresthesia and no burning pain, autonomic dysfunction, or allodynia, her symptoms seem to align more with sensorimotor neuropathy caused by absolute hypoglycemia, as has been well documented in animal models and some human cases of insulinoma. 2 - 4 , 17 - 19 …”

“…16 Considering the neuropathy described by the patient in our case was predominantly motor, with only mild paresthesia and no burning pain, autonomic dysfunction, or allodynia, her symptoms seem to align more with sensorimotor neuropathy caused by absolute hypoglycemia, as has been well documented in animal models and some human cases of insulinoma. [2][3][4][17][18][19] Clinicians should keep in mind the potential need for gradual reduction of blood sugar in patients with long-term poorly controlled diabetes to prevent the development of TIND, especially considering the true prevalence of TIND is still not known. Although regarded as a relatively rare disorder, there has been an increase in the number of reported cases of TIND over the last 10 years.…”

“…There have been, however, several reports of hypoglycemic neuropathy associated with insulinoma. 2 - 4 Also of note are reports of painful peripheral neuropathy in diabetic patients with long-standing hyperglycemia following a swift and drastic decrease to normal blood glucose levels, 5 - 7 a phenomenon referred to as TIND. 6 …”

Post-herpetic neuralgia

“…It is presented with sensory-motor pattern, with predominance of upper limbs (UULL), with presence of atrophy, and may be reversible after treating the hypoglycemic condition 28,29 . 24 .…”