João Sérgio Neves1,2, Luís Teles3, Vanessa Guerreiro4,5, Eva Lau4,5,6, Ana Isabel Oliveira4, Luís Graça7, José Manuel Lopes5,6,8, Paula Freitas4,5,6, Davide Carvalho4,5,6. 1. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal. jsneves@med.up.pt. 2. Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal. jsneves@med.up.pt. 3. Department of Internal Medicine, Centro Hospitalar entre Douro e Vouga, Santa Maria da Feira, Portugal. 4. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal. 5. Faculdade de Medicina, Universidade do Porto, Porto, Portugal. 6. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. 7. Department of Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal. 8. Department of Pathology and Oncology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Abstract
PURPOSE: Insulinomas are pancreatic endocrine tumors characterized by hypoglycemia resulting from hypersecretion of insulin. The long-term impact of surgical treatment of insulinomas, particularly the risk of glucose metabolism disorders, remains largely unknown. METHODS: We retrospectively evaluated all patients with insulinoma submitted to surgery at Centro Hospitalar Universitário de São João (Porto, Portugal) between 1980 and 2016. We evaluated baseline characteristics of patients at presentation, imaging evaluation, surgical treatment, characteristics of the tumors, perioperative complications, disease remission, and long-term follow-up and metabolic outcomes. RESULTS: Twenty-eight patients with insulinomas submitted to surgical treatment were included. Sixty-one percent were female, and the average age was 46.4 years. The most reported symptoms were confusion (72%) and diaphoresis (56%). The most used imaging technique was abdominal CT (72%), and the test with the highest percentage of positive results was endoscopic ultrasound (80%). The most used surgical procedure was partial pancreatic resection (71%). The mean tumor diameter was 2.1 cm and 11% of the tumors had lymph node involvement at diagnosis. Pancreatic fistula was the most common postoperative acute complications (21%). After surgery, patients were followed for a median time of 80 months (25th-75th percentile: 20-148 months). Eight patients (32%) developed glucose metabolism disorders (seven developed diabetes and one prediabetes). One of these patients developed albuminuria, and no macrovascular complications were observed during the follow-up. CONCLUSIONS: Disorders of glucose metabolism are a frequent complication during follow-up of surgically treated insulinomas. The prevention, early diagnosis, and treatment of diabetes should be a priority in the follow-up of these patients.
PURPOSE:Insulinomas are pancreatic endocrine tumors characterized by hypoglycemia resulting from hypersecretion of insulin. The long-term impact of surgical treatment of insulinomas, particularly the risk of glucose metabolism disorders, remains largely unknown. METHODS: We retrospectively evaluated all patients with insulinoma submitted to surgery at Centro Hospitalar Universitário de São João (Porto, Portugal) between 1980 and 2016. We evaluated baseline characteristics of patients at presentation, imaging evaluation, surgical treatment, characteristics of the tumors, perioperative complications, disease remission, and long-term follow-up and metabolic outcomes. RESULTS: Twenty-eight patients with insulinomas submitted to surgical treatment were included. Sixty-one percent were female, and the average age was 46.4 years. The most reported symptoms were confusion (72%) and diaphoresis (56%). The most used imaging technique was abdominal CT (72%), and the test with the highest percentage of positive results was endoscopic ultrasound (80%). The most used surgical procedure was partial pancreatic resection (71%). The mean tumor diameter was 2.1 cm and 11% of the tumors had lymph node involvement at diagnosis. Pancreatic fistula was the most common postoperative acute complications (21%). After surgery, patients were followed for a median time of 80 months (25th-75th percentile: 20-148 months). Eight patients (32%) developed glucose metabolism disorders (seven developed diabetes and one prediabetes). One of these patients developed albuminuria, and no macrovascular complications were observed during the follow-up. CONCLUSIONS: Disorders of glucose metabolism are a frequent complication during follow-up of surgically treated insulinomas. The prevention, early diagnosis, and treatment of diabetes should be a priority in the follow-up of these patients.
Authors: Rajesh V Thakker; Paul J Newey; Gerard V Walls; John Bilezikian; Henning Dralle; Peter R Ebeling; Shlomo Melmed; Akihiro Sakurai; Francesco Tonelli; Maria Luisa Brandi Journal: J Clin Endocrinol Metab Date: 2012-06-20 Impact factor: 5.958
Authors: D Grama; B Eriksson; H Mårtensson; B Cedermark; B Ahrén; A Kristoffersson; J Rastad; K Oberg; G Akerström Journal: World J Surg Date: 1992 Jul-Aug Impact factor: 3.352
Authors: Philip E Cryer; Lloyd Axelrod; Ashley B Grossman; Simon R Heller; Victor M Montori; Elizabeth R Seaquist; F John Service Journal: J Clin Endocrinol Metab Date: 2008-12-16 Impact factor: 5.958