Usefulness of artificial endocrine pancreas during resection of insulinoma

Hirose, Kenichi; Kawahito, Shinji; Mita, Naoji; Takaishi, Kazumi; Kawahara, Tomiya; Soga, Tomohiro; Katayama, Toshiko; Imura, Satoru; Morine, Yuji; Ikemoto, Tetsuya; Shimada, Mitsuo; Matsuhisa, Munehide; Kitahata, Hiroshi

doi:10.2152/jmi.61.421

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…To avoid hyperglycemia or hypoglycemia some authors even use an artificial endocrine pancreas or continuous glucose infusion to control blood glucose concentration in patients with insulinoma during and after insulinoma resection [9,11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Beside these problems in regulatory adaption of glucose metabolism also permanent postoperative diabetes mellitus has been shown by some authors in patients with successful insulinoma resection [8,9]. Some of these patients have suffered from a coexisting diabetes mellitus [10] and it occurred that diabetes mellitus was only masked by the activity of an insulinoma.…”

Section: Discussionmentioning

confidence: 99%

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

Akca

Starke

Dobek

et al. 2019

Exp Clin Endocrinol Diabetes

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Akca

Starke

Dobek

et al. 2019

Exp Clin Endocrinol Diabetes

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“…An AP fulfills the requirement of continuous blood glucose measurement and promptly and automatically responds to the need for glucose or insulin infusion without delay, thus achieving stable target glycemic values [8]. The device is reportedly beneficial for patients with insulinoma in that it rapidly responds to changes in the glucose level and obtains stable glycemic control [3]. The present case implicates that an AP is likely to be efficacious during the surgery even in patients with NICTH, although further case reports are needed to fully elucidate its effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…An artificial endocrine pancreas (AP) is capable of continuous measurement of the blood glucose level with automatic adjustment of the insulin or glucose infusion rate to achieve stable glycemic control. Its efficacy has been reported in patients with insulinoma [3], although its benefits in patients with NICTH with IGF2 elevation remain unclear. We herein report a case involving resection of an IGF2-producing pleural solitary fibrous tumor (SFT) using an AP.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative glycemic control using an artificial endocrine pancreas in a patient with a recurrent pleural solitary fibrous tumor producing insulin-like growth factor 2: a case report

et al. 2019

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Background: Non-islet cell tumor producing insulin-like growth factor 2 involves hypoglycemia. During tumor resection, intense fluctuation of blood glucose level may occur. An artificial endocrine pancreas has been reported as beneficial for patients with insulinoma as it maintains stable glycemic levels, although scarcely described with insulin-like growth factor 2-releasing tumor. Case presentation: An 84-year-old man had a recurrent left pleural solitary fibrous tumor releasing high molecular weight insulin-like growth factor 2 and experienced a frequent syncope accompanied by hypoglycemia. After anesthesia induction, an artificial endocrine pancreas, STG-55, was connected to the patient. Blood glucose level was stable at around 150 mg/dl during the resection surgery. The patient followed an uneventful course and was discharged without any complications. Conclusions: An artificial endocrine pancreas may have the potential to stabilize the intraoperative blood glucose change in insulin-like growth factor 2-releasing tumor resection.

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“…3 The usefulness of CGMS in enabling detection of hypoglycemia episodes and in monitoring the effectiveness of applied treatment was reported in a few cases. [57][58][59][60] Unfortunately, CGMS clinical use is limited due to its high cost and low availability and the several technical issues they still exhibit (requirement of frequent calibration and not always accurate measurement of glucose levels).…”

Section: Continuous Glucose Monitoring Systemsmentioning

confidence: 99%

Glycemic control in patients with insulinoma

Matej¹,

Bujwid²,

Wroński³

2017

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Insulinoma is the most common neuroendocrine tumor of the pancreas. surgical management of insulinomas is considered to be the only curative method. however, effective glycemic control preoperatively and in unresectable insulinomas remains a significant issue. hyperinsulinism, occurring as a result of the hormone-secreting tumor, leads to life-threatening hypoglycemia episodes which require urgent medical treatment. This article discusses current management of hypoglycemia in insulinoma patients, including: education and lifestyle modifications, pharmacotherapy (diazoxide, somatostatin analogs, mTor inhibitor -everolimus), cytoreductive methods and continuous glucose monitoring systems.

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Usefulness of artificial endocrine pancreas during resection of insulinoma

Cited by 9 publications

References 22 publications

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

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

Intraoperative glycemic control using an artificial endocrine pancreas in a patient with a recurrent pleural solitary fibrous tumor producing insulin-like growth factor 2: a case report

Glycemic control in patients with insulinoma

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