恶性巨胰岛素瘤所致复发性低血糖1例

Clareza Arief Wardhana, A. A. Lestari, I. Wande
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摘要

胰岛素瘤是胰腺的一种功能性内分泌肿瘤,是内源性高胰岛素血症引起低血糖的最常见原因。胰岛素瘤是一种罕见的病例,每年的发病率为每百万人1-4例。恶性胰岛素瘤是一种可以转移到其他组织的胰岛素瘤,仅发生在5-10%的胰岛素瘤病例中。大小>9 cm的胰岛素瘤为巨大胰岛素瘤。自1927年以来,报道的巨型胰岛素瘤病例不到40例。女,56岁,主诉为反复低血糖导致意识下降。体格检查,可触及±12x4 cm实心肿块,表面不均匀。实验室测试发现c肽、空腹胰岛素和肝功能测试都有所增加。对比CT扫描发现胰腺尾部和肝尾部有一个7.6x8.6x13.6 cm的不均匀实性肿块,并伴有多发转移结节。胰腺和肝脏活检结果显示低分化癌转移到肝脏。本病例,结合患者病史、体格检查等,诊断为观察到巨大胰岛素瘤伴肝转移引起的复发性低血糖。
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Patient with Recurrent Hypoglycemia Caused by Malignant Giant Insulinoma
Insulinoma is a functional endocrine tumor in the pancreas and the most common cause of hypoglycemia due to endogenic hyperinsulinism. Insulinoma is a rare case, with an incidence of 1-4 cases per million people each year. Malignant insulinoma is an insulinoma that is proven to metastasize to other tissues and only happens in 5-10% of insulinoma cases. Insulinoma with a size >9 cm is classified as giant insulinoma. Since 1927, fewer than 40 cases of giant insulinoma have been reported. 56 years old female was referred from a private hospital with the chief complaint of decreased consciousness due to recurrent hypoglycemia. On physical examination, palpable ±12x4 cm solid mass with an uneven surface in the epigastric region. Laboratory tests found an increase in c-peptide, fasting insulin, and liver function tests. A contrast CT scan found a heterogeneous solid mass 7.6x8.6x13.6 cm in cauda of the pancreas and hepatomegaly with multiple metastatic nodules. Results of pancreas and liver biopsy showed poorly differentiated carcinoma that metastasizes to the liver. In this case, based on patient history, physical and other examinations, it can be concluded that the patient was diagnosed with an observation of recurrent hypoglycemia caused by giant insulinoma with liver metastases.
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