[Diagnostic localization of insulinoma and prognostic value of postoperative glycemia monitoring].
BACKGROUND
Our purpose was to establish the efficacy of different diagnostic tests for the diagnosis and localization of insulinoma as well as the prognostic value of postoperative glycemia measurements.


METHODS
Retrospective analysis of all insulinoma patients diagnosed at our hospital over the last fifteen years. Every patient underwent a supervised prolonged fasting and localization imaging tests were performed in positive cases. In the immediate preoperative period, during surgical intervention and immediately after it, an intravenous dextrose solution (10% concentration, 2-3 g/Kg/d infusion rate) was used to avoid hypoglycemia. Glycemia was measured every 6-8 h from the immediate postoperative period until hospital discharge.


RESULTS
Seventeen insulinoma cases were identified (incidence 2.5 cases/million/year), 59% women and 41% men. The sensitivity (and positive predictive value) of diagnostic tests was: conventional-contrast CT scan 30% (75%), spiral CT scan 71.42% (100%), arteriography 28.57% (100%) and intraoperative ultrasonography 100% (100%). MRI identified insulinoma in two out of five patients and In-pentetreotide scintigraphy only in one out of five. Patients subsequently developing diabetes mellitus or glucose intolerance had higher levels of postoperative glycemia, which also lasted for more days, and longer need for insulin therapy. However, patients with a recurrence of the tumor did not show rebound hyperglycemia at all.


CONCLUSIONS
Postoperative glycemia could be a useful prognostic factor in patients who develop diabetes mellitus or glucose intolerance after resection of insulinoma and to predict insulinoma recurrence.
Botella Carretero
José Ignacio
JI
Servicios de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, Spain. jibotella@wanadoo.es
Valero González
Miguel Angel
MA
Lahera Vargas
Marcos
M
Aréchaga
Santiago
S
de Juan
Agustín
A
Varela Da Costa
César
C
Sancho
José
J
D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D011182:Postoperative Care; D011379:Prognosis; D012189:Retrospective Studies
D001786:Blood Glucose