Glucose-responsive and Octreotide-sensitive Insulinoma

DOI Web Site 被引用文献4件 参考文献26件
  • Izumiyama Hajime
    Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School
  • Gotyo Naoki
    Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School
  • Fukai Nozomi
    Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School
  • Ozawa Naoko
    Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School
  • Doi Masaru
    Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School
  • Yoshimoto Takanobu
    Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School
  • Arii Sigeki
    Department of Hepato-Billiary-Pancreatic Surgery, Tokyo Medical and Dental University Graduate School
  • Hirata Yukio
    Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University Graduate School

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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.<br>

収録刊行物

  • Internal Medicine

    Internal Medicine 45 (8), 519-524, 2006

    一般社団法人 日本内科学会

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