胰島素瘤之定位－病例報告及文獻回顧

Localization of Insulinoma-A Case Report and Review of Literature

葉玉雄(Yit-Sheung Yap) ； 陳榮福(Jung-Fu Chen) ； 黃淑華(Shu-Hua Huang)

《中華民國內分泌暨糖尿病學會會刊》 21卷3期 (2008/04) Pp. 27-34

https://doi.org/10.7101/ED.200804.0027

摘要

在成人中，胰島素分泌過多引致低血糖最常見的原因是胰島素瘤(Insulinoma)。手術是唯一治愈的方式，因此手術前種瘤定位就變很重要，然而傳統的影像檢查都有低敏感度或侵犯性的缺點。本篇是報告一位35歲男性因常頭暈，因此到醫院去進行健康檢查，檢查發現血糖過低（空腹血糠爲30mg/dl）且血清胜肽(C-peptide)濃度和胰島素濃度偏高，證實爲高胰島素性低血糠症(hyperinsulinemic hypoglycemia)，強烈懷疑爲胰島素素瘤。病患沒有糖尿病史，近一年來常跌倒摔傷而且住院前幾個月還發生車禍，曾因失眠問題服用一些草藥。住院時，安排電腦斷層(computed tomography; CT)及胃腸內視鏡超音波(endoscopic ultrasound; EUS)都無法發現腫瘤，最後是進行了血管攝影(angiography)才定位出腫瘤位置。同時也安排去氧氟化葡萄糖(2-deoxy-2[18F] fluoro-D-glucose; 18FDG)正子斷層造影(positron emission tomography; PET)，期望應用其偵測原理看是否能發現腫瘤位置，但結果卻未能顯現及定位。病患術中冷凍切片(frozen section)證實爲胰島素細胞腫瘤(islet cell tumor)，診斷爲胰烏素瘤，病人也在手術後空腹血糖、C-peptide濃度和胰島素濃度回復接近正常，且再無低血糖症狀發作。目前病人持續在新陳代謝門診追蹤當中。回顧最新的文獻，反而發現最新術前定位胰島素瘤位置是使用Fluoride-18-L-dihydroxyphenylalanine(18F-DOPA)PET，其敏感度不錯。

關鍵字

胰島素瘤 ； 定位

並列摘要

In adults, insulinoma is the most common cause of hyperinsulinemic hypoglycemia. Surgical excision of the lesion is the only choice for core, thus preoperative localization of these tumors provides important support for the surgeon. However, the conventional imaging studies either have low sensitivity or are invasive procedure. Here, we report a case. A 35 years old male patient suffered from dizziness frequently. Hence be went to hospital for health examination where inappropriate elevation of C-peptide level and insulin level were detected during hypoglycemia (ac sugar: 30 mg/dl).Thus hyperinsulinemic hypoglycemia due to insulinoma is highly suspected. lie has no history of diabetes, often fell doss n without cause in recent one year and even admitted to a local hospital due to traffic accident few months ago. He has taken some herb drugs for sleep disorder before. During hospitalization, computed tomography and endoscopic ultrasound were performed but no tumor growth was shown in the pancreas or other visceral organs. Tumor was successfully localized by angiography examination at last. We have performed 2-deoxy-2[l8F]fluoro-D-glucose (18FDG) positron emission tomography(PET) in the detection of insulinoma hut the result is disappointed. Review recent literature, PET combined with fluorine-18-1-dihydroxyphenylalanine (18F-DOPA) has been used as a preoperative tool to localize insulinoma, with established high sensitivity characteristic. Intraoperative frozen section confirmed an islet cell tumor, with high possibility of insulinoma, Fasting blood sugar, C-peptide and insulin levels recovered to near normal range post operation. At present time, this patient keeps follow sip at our Endocrinology and Metabolism outpatient clinic.

並列關鍵字

Insulinoma ； Localization