Trends in Presentation and Management of Endogenous Hyperinsulinaemic Hypoglycaemia Over the Last Three Decades at a Tertiary Care Centre (1992-2022).

Indian Journal of Endocrinology and Metabolism Pub Date : 2024-07-01 Epub Date: 2024-08-28 DOI:10.4103/ijem.ijem_87_24

Setu Gupta, Alpesh Goyal, Devasenathipathy Kandasamy, Shipra Agarwal, Nishikant Damle, Sujoy Pal, Nikhil Tandon, Viveka P Jyotsna

{"title":"Trends in Presentation and Management of Endogenous Hyperinsulinaemic Hypoglycaemia Over the Last Three Decades at a Tertiary Care Centre (1992-2022).","authors":"Setu Gupta, Alpesh Goyal, Devasenathipathy Kandasamy, Shipra Agarwal, Nishikant Damle, Sujoy Pal, Nikhil Tandon, Viveka P Jyotsna","doi":"10.4103/ijem.ijem_87_24","DOIUrl":null,"url":null,"abstract":"Introduction: Endogenous hyperinsulinaemic hypoglycaemia (EHH) is characterized by inappropriate insulin secretion from pancreatic beta cells despite low blood glucose concentrations. We aimed to evaluate the secular changes in presentation and management of EHH due to insulinoma/non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) at our centre.Methods: This was a single-centre ambispective study (2014-2022). The clinical, biochemical, hormonal and radiological parameters (n = 63) collected as part of this study were compared with our earlier studies (1992-2005, n = 31; and 2006-2013, n = 35) and with other centres across the world.Results: A total of 63 patients (39 males) with a preoperative diagnosis of EHH (insulinoma, n = 58; and NIPHS, n = 5) and a mean age of 40.7 years were studied. The mean lag time from the onset of symptoms to diagnosis decreased from 4.6 years during the first study period to 1.9 years during this study period. However, the majority presented with fasting hypoglycaemia of 98.4%, and both fasting and postprandial hypoglycaemia of 32%. Exclusive postprandial hypoglycaemia was present in 1.7% of insulinoma. A histopathological diagnosis of insulinoma was made in 52 patients and nesidioblastosis in two patients. Intraoperative ultrasonography (IOUS) and intraoperative palpation (IOP) yielded 100% sensitivity, while endoscopic ultrasonography (EUS) and 68Ga-DOTA-Exendin-4 positron emission tomography/computed tomography (PET/CT) yielded sensitivity of 86% and 85%, respectively, for localizing insulinoma. Resolution of hypoglycaemia was noted in 53 of 57 (93%) patients who underwent surgery with a preoperative diagnosis of insulinoma.Conclusion: We observed a trend towards earlier diagnosis of EHH, increased patient numbers and availability of nuclear imaging techniques for preoperative localization in the last decade compared to earlier.","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"28 4","pages":"363-369"},"PeriodicalIF":0.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451956/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Endocrinology and Metabolism","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/ijem.ijem_87_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/28 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Endogenous hyperinsulinaemic hypoglycaemia (EHH) is characterized by inappropriate insulin secretion from pancreatic beta cells despite low blood glucose concentrations. We aimed to evaluate the secular changes in presentation and management of EHH due to insulinoma/non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) at our centre.

Methods: This was a single-centre ambispective study (2014-2022). The clinical, biochemical, hormonal and radiological parameters (n = 63) collected as part of this study were compared with our earlier studies (1992-2005, n = 31; and 2006-2013, n = 35) and with other centres across the world.

Results: A total of 63 patients (39 males) with a preoperative diagnosis of EHH (insulinoma, n = 58; and NIPHS, n = 5) and a mean age of 40.7 years were studied. The mean lag time from the onset of symptoms to diagnosis decreased from 4.6 years during the first study period to 1.9 years during this study period. However, the majority presented with fasting hypoglycaemia of 98.4%, and both fasting and postprandial hypoglycaemia of 32%. Exclusive postprandial hypoglycaemia was present in 1.7% of insulinoma. A histopathological diagnosis of insulinoma was made in 52 patients and nesidioblastosis in two patients. Intraoperative ultrasonography (IOUS) and intraoperative palpation (IOP) yielded 100% sensitivity, while endoscopic ultrasonography (EUS) and 68Ga-DOTA-Exendin-4 positron emission tomography/computed tomography (PET/CT) yielded sensitivity of 86% and 85%, respectively, for localizing insulinoma. Resolution of hypoglycaemia was noted in 53 of 57 (93%) patients who underwent surgery with a preoperative diagnosis of insulinoma.

Conclusion: We observed a trend towards earlier diagnosis of EHH, increased patient numbers and availability of nuclear imaging techniques for preoperative localization in the last decade compared to earlier.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

一家三级医疗中心过去三十年来内源性高胰岛素血症低血糖症的表现和处理趋势（1992-2022）。

简介内源性高胰岛素血症性低血糖症（EHH）的特点是，尽管血糖浓度较低，但胰岛β细胞仍会不适当地分泌胰岛素。我们旨在评估本中心因胰岛素瘤/非胰岛素瘤胰源性低血糖综合征（NIPHS）引起的 EHH 的表现和管理方面的长期变化：这是一项单中心前瞻性研究（2014-2022 年）。本研究收集的临床、生化、激素和放射学参数（n = 63）与本中心早期的研究（1992-2005 年，n = 31；2006-2013 年，n = 35）以及全球其他中心的研究进行了比较：共有 63 名患者（39 名男性）在术前诊断为 EHH（胰岛素瘤，58 人；NIPHS，5 人），平均年龄为 40.7 岁。从出现症状到确诊的平均滞后时间从第一次研究期间的 4.6 年缩短至本次研究期间的 1.9 年。然而，大多数患者都出现了空腹低血糖，占 98.4%，同时出现空腹和餐后低血糖的患者占 32%。1.7%的胰岛素瘤患者仅出现餐后低血糖。52 名患者的组织病理学诊断为胰岛素瘤，2 名患者的组织病理学诊断为胰岛素母细胞瘤。术中超声（IOUS）和术中触诊（IOP）对胰岛素瘤定位的敏感度为100%，而内窥镜超声（EUS）和68Ga-DOTA-Exendin-4正电子发射断层扫描/计算机断层扫描（PET/CT）对胰岛素瘤定位的敏感度分别为86%和85%。术前诊断为胰岛素瘤并接受手术治疗的 57 例患者中，有 53 例（93%）的低血糖症状得到缓解：我们观察到，与早期相比，近十年来胰岛素瘤的诊断有提前的趋势，患者人数增加，核成像技术可用于术前定位。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Indian Journal of Endocrinology and Metabolism Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

2.10

自引率

0.00%

发文量

期刊介绍： The Indian Journal of Endocrinology and Metabolism (IJEM) aims to function as the global face of Indian endocrinology research. It aims to act as a bridge between global and national advances in this field. The journal publishes thought-provoking editorials, comprehensive reviews, cutting-edge original research, focused brief communications and insightful letters to editor. The journal encourages authors to submit articles addressing aspects of science related to Endocrinology and Metabolism in particular Diabetology. Articles related to Clinical and Tropical endocrinology are especially encouraged. Sub-topic based Supplements are published regularly. This allows the journal to highlight issues relevant to Endocrine practitioners working in India as well as other countries. IJEM is free access in the true sense of the word, (it charges neither authors nor readers) and this enhances its global appeal.