Insulinoma presenting with post-prandial hypoglycaemia following fundoplication
| العنوان: | Insulinoma presenting with post-prandial hypoglycaemia following fundoplication |
|---|---|
| المؤلفون: | Alan Pham, Sarah Y. Qian, Duncan J. Topliss, Matthew J.L. Hare |
| المصدر: | Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-6 (2018) Endocrinology, Diabetes & Metabolism Case Reports |
| بيانات النشر: | Bioscientifica, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Endoscopic ultrasound, medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Nissen fundoplication, lcsh:Diseases of the endocrine glands. Clinical endocrinology, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, Medicine, Insulinoma, lcsh:RC648-665, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Unique/Unexpected Symptoms or Presentations of a Disease, medicine.disease, medicine.anatomical_structure, Positron emission tomography, 030220 oncology & carcinogenesis, Pancreatectomy, Dumping syndrome, Radiology, business, Pancreas, hormones, hormone substitutes, and hormone antagonists |
| الوصف: | Summary Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an uncommon and challenging case of insulinoma soon after upper gastrointestinal surgery. A 63-year-old man presented with 6 months of post-prandial hypoglycaemia beginning after a laparoscopic revision of Toupet fundoplication. Hyperinsulinaemic hypoglycaemia was confirmed during a spontaneous episode and in a mixed-meal test. Localisation studies including magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and gallium dotatate positron emission tomography (68Ga Dotatate PET) were consistent with a small insulinoma in the mid-body of the pancreas. The lesion was excised and histopathology was confirmed a localised well-differentiated neuroendocrine pancreatic neoplasm. There have been no significant episodes of hypoglycaemia since. This case highlights several key points. Insulinoma should be sought in proven post-prandial hyperinsulinaemic hypoglycaemia – even in the absence of fasting hypoglycaemia. The use of nuclear imaging targeting somatostatin and GLP1 receptors has improved accuracy of localisation. Despite these advances, accurate surgical resection can remain challenging. Learning points: Hypoglycaemia is defined by Whipple’s triad and can be provoked by fasting or mixed-meal tests. Although uncommon, insulinomas can present with post-prandial hypoglycaemia. In hypoglycaemia following gastrointestinal surgery (i.e. bariatric surgery or less commonly Nissen fundoplication) dumping syndrome or non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) should be considered. Improved imaging techniques including MRI, endoscopic ultrasound and functional nuclear medicine scans aid localisation of insulinomas. Despite advances in imaging and surgical techniques, accurate resection of insulinomas remains challenging. |
| اللغة: | English |
| تدمد: | 2052-0573 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d0ba346088ee96f751df0e4ad1b482ecTest https://www.edmcasereports.com/articles/endocrinology-diabetes-and-metabolism-case-reports/10.1530/EDM-17-0131Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....d0ba346088ee96f751df0e4ad1b482ec |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20520573 |
|---|