Glucose-responsive and Octreotide-sensitive Insulinoma
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概要
- 論文の詳細を見る
Insulinoma is the most common cause of fasting hypoglycemia resulting from autonomous insulin hypersecretion. We describe herein a unique case with paradoxical hypoglycemic episodes induced by hyperglycemia. A 55-year-old female had repeated hypoglycemic episodes after meal or during increased physical activity. Although fasting (10 hr) failed to provoke hypoglycemia, oral glucose tolerance test (GTT) caused an exaggerated insulin response (885 μU/ml) at 30 min, followed by hypoglycemia (36 mg/dl) after 90 min. Moreover, intravenous GTT also induced an exaggerated insulin response (>2900 μU/ml) at 10 min, followed by hypoglycemia (34 mg/dl) after 40 min. Although MRI and CT scan of the abdomen failed to detect any mass lesions in the pancreas, Octreoscan revealed increased radioactive uptake around the pancreatic head region. Treatment with a daily injection of octreotide (100 μg) alleviated her hypoglycemic episodes. At surgery, two islet cell adenomas were identified in the pancreas and resected. Postoperatively, she was free from hypoglycemic episodes after meal. Postoperative oral and intravenous GTT did not induce hypoglycemia. Thus, this is a very rare case of glucose-responsive and octreotide-sensitive insulinoma in whom GTT and octreotide proved to be a useful provocation and treatment for hypoglycemic episodes.
- 社団法人 日本内科学会の論文
著者
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Izumiyama Hajime
Department Of Clinical And Molecular Endocrinology Tokyo Medical And Dental University Graduate Scho
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Doi Masaru
Department Of Clinical And Molecular Endocrinology Tokyo Medical And Dental University Graduate Scho
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Gotyo Naoki
Department Of Endocrinology And Metabolism Tokyo Metropolitan Toshima Hospital
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Hirata Yukio
Department Of Anatomy And Embryology Tokyo Metropolitan Institute For Neurosciences:(present)departm
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Ozawa Naoko
Department Of Clinical And Molecular Endocrinology Tokyo Medical And Dental University Graduate Scho
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Fukai Nozomi
Department Of Clinical And Molecular Endocrinology Tokyo Medical And Dental University Graduate Scho
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Yoshimoto Takanobu
Department Of Clinical And Molecular Endocrinology Tokyo Medical And Dental University
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DOI Masaru
Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School
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Arii Sigeki
Department of Hepato-Billiary-Pancreatic Surgery, Tokyo Medical and Dental University Graduate School
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