Early Postoperative Fasting Serum Glucose Levels are Useful in Depicting Future Diabetes Mellitus in Patients with Curative Insulinoma Surgery

Abstract

Background Hyperglycemia has been reported in some patients after curative insulinoma resection but no systematic investigation of glucose metabolism has been shown in a larger cohort of these patients. Therefore, it is still unknown, whether long lasting hyperinsulinism in insulinoma patients induces insulin resistance, which may jeopardize the postoperative health status of these patients. Methods Early postoperative fasting serum glucose levels were measured in all insulinoma patients after curative tumor resection during the first 48 h, being operated between 2011 and 2018, retrospectively. Results Of 77 (100%) patients with benign, spontaneous occuring insulinoma 51 (66.2%) patients were operated on by tumor enucleation. In 15 (19.5%) patients a left pancreatic resection was performed and in 11 (14.3%) patients the pancreatic head or the middle console of pancreatic corpus were excised. In 32 (41.6%) cases the highest fasting postoperative glucose levels were measured between 140–200 mg/dl. In 16 (20.8%) patients the glucose serum levels reached values above 200 mg/dl and in 4 (5.2%) patients short term substitution with insulin was indicated. Only one (1.3%) of these patients developed diabetes mellitus with the need of ongoing insulin treatment. Major postoperative complications were registered in 31 of all 77 patients (40.3%) and in 9 of 16 patients (56.3%) with postoperative glucose levels above 200 mg/dl. This difference was not statistically significant. Conclusions Early postoperative (first 48 h) fasting serum glucose levels in insulinoma patients showed significant hyperglycemia above 200 mg/dl in only few patients (20.8%) and chronic postoperative Diabetes mellitus developed in only one of 77 patients (<2%). Therefore, recovery of glucose metabolism after insulinoma resection is fast and medical intervention is not mandatory in most of these patients.

Uso de monitor continuo de glucosa en un paciente con insulinoma en tratamiento inicial con diazóxido y debut de diabetes mellitus luego de cirugía

“…Akca et al encontraron hiperglucemia significativa por encima de 200 mg/dl (20,8 %) y diabetes mellitus postoperatoria en solo uno de 77 individuos (<2 %). 12 Nockel et al demostraron que el 36% desarrolló hiperglucemia dentro de las 24 h y el 36% fueron tratados con insulina. 10 Nuestro grupo previamente reportó el uso del MCG y yudó a reducir los episodios de hipoglicemia en pacientes con DM tipo 1.…”

What Are the Place and Modalities of Surgical Management for Pancreatic Neuroendocrine Neoplasms? A Narrative Review

“…As therapeutic alternatives, endoscopic approaches involving ultrasound-guided radiofrequency ablation and ethanol injection are emerging and can also be considered [ 84 , 85 , 86 ]. Glucose metabolism recovery after resection of insulinoma seems to occur in most of the cases in a recent retrospective study including 77 patients treated with enucleation, with only one patient presenting with chronic diabetes mellitus requiring treatment [ 87 ]; however, blood glucose should be monitored carefully during hospitalization and after discharge, as a few patients need small doses of insulin for a period of several days or weeks [ 79 ].…”