[Contribution of the artificial pancreas in the diagnosis and surgical treatment of insulinomas].
Insulinomas are often hard to diagnose and difficult to locate during surgery. We tested the contribution of artificial pancreas (AP) for case management of our last eight patients including two cases with multiple insulinomas. When diagnosis is uncertain, the euglycemic hyperinsulinic clamp technique under AP is a safe method to assess inappropriate insulin secretion characterized by a high plasma level of C peptide not inhibited by insulin injection. During surgery the AP provides a feed back controlled glucose infusion and thus maintains blood glucose above a predefined level. It allows a safe operation, preventing sudden hypoglycemia. By providing continuous data about intensity of glucose infusion and blood glucose, it helps to detect an occult secreting tumor (a preoperative therapeutic test with diazoxide requires stopping treatment for at least one month before surgery to avoid false negative results) and confirms the total ablation of abnormal insulin-producing cells. Peroperative monitoring curves of glucose infusion and blood glucose related to exploration and ablation procedures illustrate the contribution of this method in helping surgical treatment which can be perfectly adapted to the lesions as shown by the total recovery of our eight patients (mean follow-up: 43.2 months).
Parneix
M
M
Clinique Chirurgicale, Hôpital Saint-André, Bordeaux.
Rullier
E
E
Gin
H
H
Roche
A
A
D001187:Artificial Organs; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000097:blood*; D007332:Insulin Infusion Systems; D007340:Insulinoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D012016:Reference Values
D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin
Apport du pancréas artificiel dans le diagnostic et le traitement chirurgical des insulinomes.