A Case of Insulinoma with Hypoglycemic Attacks Successfully Treated with Somatostatin Analogue.

概要

論文の詳細を見る
A 72-year-old woman was admitted to our hospital in October 1988 because of hypoglycemic coma. Her laboratory data on admmission showed FBS 36 mg/dl, serum IRI 13μU/ml, and serum CPR 2.6ng/ml. However, IRI/FBS ratio (0.36) and CPR/FBS ratio (0.072) were relatively high. Abdominal echogram, CT scan, and MRI revealed no pancreatic tumors. IRI measurements by PTPC were compatible with insulinoma of the pancreatic tail. Because of frequent hypoglycemic attack, she was treated with 50-150, μg/day of somatostatin analogue (SMS 201-995) for 4 weeks. During SMS 201-995 treatment, her FBS levels increased from 43.2±6.1 to 97.9±3.3 mg/dl, and her serum IRI and CPR levels decreased from 18.0±7.1 and 1.69±0.59 to 4.3±1.3, μU/ml and 1.00±0.24 ng/ml, respectively. In this case, SMS 201-995 was very useful for preoperative management of hypoglycemic attacks. In July 1989, distal pancreatectomy was performed, and an islet cell tumor (8 mm in diameter) was found in the tail. After operation, the hypoglycemic attacks disappeared. Although glucose, glucagon and arginine load tests before SMS 201-995 treatment showed low responses of serum IRI and CPR, the responses to these tests after 2 to 3 weeks of treatment were rather excessive. It is suggested that SMS 201-995 treatment in this case might have altered the insulin response to the exogenous stimulants.
一般社団法人日本糖尿病学会の論文