Case Report on Diagnostic and Treatment of Insulinoma

Morugova T. V.
Doctor of Medicine, Professor, Head, Chair for Endocrinology¹

Ibragimova O. Y.2
PhD, Head, Department for Endocrinology²

Artamonova I. V.
PhD, Endocrinologist²

Avzaletdinova D. Sh.
PhD, Assistant Professor, Chair for Endocrinology¹

1 - Bashkir State Medical University, Ufa, Russia
2 - City Clinical Hospital # 21, Ufa, Russia

Corresponding Author: Avzaletdinova Diana; e-mail: hyppocrat@mail.ru. Conflict of interest: None declared. Funding: The study had no sponsorship.

In the article authors present the case report of late diagnostic and treatment of 6 mm insulinoma located in the head of pancreas in 60 years old female patient. The disease manifested as an acute cerebrovascular disease and proceeded atypically. None of the imaging studies, including selective angiography combined with hepatic venous sampling for insulin after intra-arterial calcium administration has given an idea of an unambiguous disposition of a tumor. Intraoperative pancreas exploration by palpation ended in wrong localization of insulinoma. Contradictory data of topic diagnostics have caused the inadequate volume of primary surgical treatment causing the necessity of repeated surgery. Long-term persistent hypoglycemia induced encephalopathy and multiple organ failure resulted in lethal outcome although the source of insulin excess has been liquidated. This clinical case emphasizes need of vigilance concerning insulin-producing tumors at patients with clinical picture of stroke in combination with a hypoglycemia.

tumor of pancreas, insulin, beta-cells

10.29234/2308-9113-2018-6-4-28-38

1. Bel’tsevich D.G. Soglasitel’nyye rekomendatsii ENETS (Evropeyskoye obshchestvo po neyroendokrinnym opukholyam) po vedeniyu bol’nykh s neyroendokrinnymi opukholyami zheludochno-kishechnogo trakta: funktsioniruyushchiye neyroendokrinnyye opukholi podzheludochnoy zhelezy. [ENETS (European Neuroendocrine Tumors Society) Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes]. Endokrinnaya khirurgiya [Endocrine surgery] 2012; (3): 10-40 (In Russ.)

2. Volkova N.I., Porksheyan M.I., Kanayeva M.A. et. al. Klinicheskiy sluchay redkoy neyroendokrinnoy opukholi podzheludochnoy zhelezy – proinsulinomy. [Clinical case of rare neuroendocrine tumor of pancreas – proinsulinoma]. Endokrinnaya khirurgiya [Endocrine surgery] 2015; 9(4): 26-31. doi: 10.14341/serg2015426­_31 (In Russ.)

3. Dedov I.I., Mel’nichenko G.A. Endokrinologiya: natsional’noye rukovodstvo [Endocrinology: national manual]. Moscow: GEOTAR-Media, 2016. (In Russ.)

4. Krivko A.A., Mel’nichenko G.A., Kuznetsov N.S. i soavt. Sovremennyye tekhnologii v diagnostike i lechenii insulinomy. [Modern technologies for diagnostics and treatment of insulinoma]. Problemy endokrinologii [Problems of Endocrinology] 2013; (5): 36-41 (In Russ.)

5. Sokolov Yu.Yu., Melikyan M.A., Karpachev S.A. Laparoskopicheskaya distal’naya rezektsiya podzheludochnoy zhelezy u 16-letney devochki s insulinomoy. [Laparoscopic distal pancreatectomy in 16 years girl with insulinoma]. Endokrinnaya khirurgiya [Endocrine Surgery] 2016; 10(3): 26-32. doi: 10.14341/serg2016326­_32 (In Russ.).

6. de Herder W.W., Niederle B., Scoazeс J.Y. et al. Well Differentiated Pancreatic Tumor/Carcinoma: Insulinoma. Neuroendocrinology 2006; 84: 183-188.

7. Guettier J.M., Gorden P. Insulin secretion and insulin-producing tumors. Expert Rev Endocrinol. Metab. 2010; 5: 217–227.

8. Thompson S.M., Vella A., Service F.J. et al. Impact of variant pancreatic arterial anatomy and overlap in regional perfusion on the interpretation of selective arterial calcium stimulation with hepatic venous sampling for preoperative localization of occult insulinoma. Surgery 2015; 158(1): 162-172. doi: 10.1016/j.surg.2015.03.004

9. Thompson S.M., Vella A., Thompson G.B. et al. Selective Arterial Calcium Stimulation with Hepatic Venous Sampling Differentiates Insulinoma From Nesidioblastosis. J Clin Endocrinol Metab 2015; 100(11): 4189-97. doi: 10.1210/jc.2015-2404.

10. Vinik A.I., Woltering E.A., Warner R.R. et al. NANETS consensus guidelines for the diagnosis of neuroendocrine tumor. Pancreas 2010; 39: 713-734.