Endogenous Hyperinsulinemia Hypoglucemic Syndrome: Surgical Treatment

Santibañes, Martín de; Cristiano, Agustín; Mazza, Oscar; Grossenbacher, Luis; Santibañés, Eduardo de; Clariá, Rodrigo Sanchez; Sivori, Enrique; Mónaco, Ricardo García; Pekolj, Juan

doi:10.1016/j.cireng.2013.04.012

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…There is, however, a controverse discussion regarding the extent of pancreatic resection in cases of NIPHS. While some patients are relieved from all symptoms upon left-sided partial/subtotal pancreatectomy, others need to undergo total pancreatectomy for symptom control [ 63 , 64 , 65 ]. Of note, surgical procedures on the pancreas, especially total pancreatectomy, are associated with a considerable risk of morbidity and mortality [ 33 , 66 , 67 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS)

Dieterle,

Husari,

Prozmann

et al. 2023

Biomedicines

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Neurovegetative and autonomic symptoms are common presentations of various diseases, ranging from psychosomatic to severe organic disorders. A 23-year-old man presented with a history of recurrent presyncope, dizziness, and tachycardia. Repeated diagnostic work-up in various clinical settings could not identify any definite cause for approximately eight years. However, the incidental detection of postprandial and exercise-induced hypoglycemia was suggestive of an insulin-related disorder. A 72 h plasma glucose fasting test revealed endogenous hyperinsulinism. Upon imaging studies, no tumor mass potentially indicating insulinoma could be detected. 68Ga-DOTA-Exendin-4 PET/CT showed diffuse tracer enrichment throughout the whole pancreas. A subtotal pancreatectomy was performed, and the diagnosis of diffuse, adult-onset nesidioblastosis was established histopathologically. This corresponds to the clinical findings of a functional β-cell disorder, also known as non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS). After nine months, the symptoms recurred, making complete pancreatectomy necessary. Postoperative laboratory evaluation exhibited no residual endogenous C-peptide production. This case illustrates the diagnostic challenges in patients presenting with unspecific, neurovegetative and autonomic symptoms with a severe and rare underlying cause.

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Section: Discussionmentioning

confidence: 99%

An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS)

Dieterle,

Husari,

Prozmann

et al. 2023

Biomedicines

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“…In our study, IOUS succeeded to localize the insulinoma in two cases but was false positive in two cases. De Santibañes revealed that IOUS allowed the detection of the pancreatic tumor from 92% to 94.7% of cases [7]. However, according to Mabrut, the sensitivity of IOUS was 86.3% and the false positive cases were related to postoperative scar fibrosis [3].…”

Section: Discussionmentioning

confidence: 99%

Endogenous hyperinsulinism: Diagnostic and therapeutic difficulties

Gouta¹,

Jerraya²,

Dougaz³

et al. 2019

Pan Afr Med J

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Endogenous hyperinsulinism is an abnormal clinical condition that involves excessive insulin secretion, related in 55% of cases to insulinoma. Other causes are possible such as islet cell hyperplasia, nesidioblastosis or antibodies to insulin or to the insulin receptor. Differentiation between these diseases may be difficult despite the use of several morphological examinations. We report six patients operated on for endogenous hyperinsulinism from 1 st January 2000 to 31 st December 2015. Endogenous hyperinsulinism was caused by insulinoma in three cases, endocrine cells hyperplasia in two cases and no pathological lesions were found in the last case. All patients typically presented with adrenergic and neuroglycopenic symptoms with a low blood glucose level concomitant with high insulin and C-peptide levels. Computed tomography showed insulinoma in one case out of two. MRI was carried out four times and succeeded to locate the lesion in the two cases of insulinoma. Endoscopic ultrasound showed one insulinoma and provided false positive findings three times out of four. Intra operative ultrasound succeeded to localize the insulinoma in two cases but was false positive in two cases. Procedures were one duodenopancreatectomy, two left splenopancreatectomy and two enucleations. For the sixth case, no lesion was radiologically objectified. Hence, a left blind pancreatectomy was practised but the pathological examination showed normal pancreatic tissue. Our work showed that even if morphological examinations are suggestive of insulinoma, other causes of endogenous hyperinsulinism must be considered and therefore invasive explorations should be carried out.

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“…Surgical resection is considered to be the only potentially curative option for patients with pancreatic neuroendocrine tumors. Frequency of surgery complications varies from 33% to 52%, while pancreatic fistulas occur in 8-19% of cases (1)(2)(3)(4)(5). Therefore, it is necessary to search for alternative methods of treatment in order to achieve better outcomes.…”

Section: Introductionmentioning

confidence: 99%

The role of microwave ablation in management of functioning pancreatic neuroendocrine tumors

et al. 2019

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Background: Surgical resection is considered to be the only potentially curative option for patients with pancreatic neuroendocrine tumors (pNETs). High risk rates of perioperative complications make minimally invasive ablative techniques a novel perspective and alternative treatment option for pancreatic neuroendocrine tumors. This study aims to present the first experience of using a microwave ablation in management of pNETs.Methods: Sechenov University has an experience of treating more than 400 patients with hormoneproducing tumors of the pancreas, 7 of which were treated by microwave ablation (MWA).Results: In all patients that underwent MWA, a regression of hormonal symptomatic was achieved. Two patients required readmission a month later for draining of pseudocyst and abscess. Conclusions:The exact role of microwave ablation in the treatment of non-metastatic pancreatic neuroendocrine tumors has not been defined yet. There is a lack of large prospective randomized studies and the reason for this is that local tumor destruction is indicated in selected cases only, thus making it difficult to analyze a large group of patients and assess long-term results of the treatment. However, microwave ablation allows to take a better control of symptoms in patients with hormone overproduction and in those with high risk of postoperative complications.

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Endogenous Hyperinsulinemia Hypoglucemic Syndrome: Surgical Treatment

Cited by 5 publications

References 21 publications

An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS)

An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS)

Endogenous hyperinsulinism: Diagnostic and therapeutic difficulties

The role of microwave ablation in management of functioning pancreatic neuroendocrine tumors

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