Multiple Proinsulin-Secreting Tumors of the Pancreas Treated by Laparoscopic Distal Pancreatectomy and Splenectomy |
| |
Authors: | Gary Clark Craig Sadur Balaram Puligandla |
| |
Institution: | (1) Department of Surgery, Kaiser-Permanente, Richmond, CA, USA;(2) Department of Endocrinology, Kaiser-Permanente, Pleasanton, CA, USA;(3) Department of Pathology, Kaiser-Permanente, Oakland, CA, USA |
| |
Abstract: | Background Patients with pancreatic tumors that induce hypoglycemia present with a myriad of symptoms. Laboratory testing can frequently
result in data challenging to the clinician to confirm the biochemical diagnosis. Proinsulin, in addition to insulin levels,
may be essential in evaluating and diagnosing an insulinoma.
Methods The objective of this case report is to demonstrate the potential importance of proinsulin levels in the evaluation of tumor-induced
hypoglycemia. We report a 49-year-old woman with an unusual clinical presentation. Unlike many patients with tumor-induced
hypoglycemia, her fasting glucose levels were fairly unimpressive, her insulin levels were undetectable during a prolonged
fast, and she had elevated proinsulin levels.
Results The inpatient fast was remarkable for levels of serum glucose 53 mg/dl or higher, a serum insulin <2 uIU/ml, C-peptide 0.7–1.1
(nl 0.8–3.1 ng/ml), and proinsulin 29.2–36.8 pmol/l (nl ≤ 18.8 pmol/l). CT scanning of the abdomen revealed multiple pancreatic
lesions. A laparoscopic distal pancreatectomy led to the removal of multiple neuroendocrine tumors, which stained only for
proinsulin and not for other pancreatic tumor markers. Postoperatively, she normalized her biochemical serum studies and has
remained symptom-free 2 years later.
Conclusions The measurement of proinsulin plays an important part in the diagnostic workup of neuroendocrine tumors causing hypoglycemia.
These potentially malignant tumors can be treated adequately with minimally invasive surgery. |
| |
Keywords: | |
本文献已被 PubMed SpringerLink 等数据库收录! |
|