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Titolo:
Unusual picture of an insulinoma in type 2 diabetes mellitus with severe obesity
Autore:
Wildbrett, J; Nagel, M; Theissig, F; Gaertner, HJ; Gromeier, S; Fischer, S; Hanefeld, M;
Indirizzi:
Techselforsch,den, Klinikum Carl Gustav Carus, Inst Poliklin Klin Stoffwech Tech Univ Dresden Dresden Germany D-01307 , Inst Poliklin Klin Stoffwech Techschirurg,sden, Klinikum Carl Gustav Carus, Klin Viszeral Thorax & Gefas Tech Univ Dresden Dresden Germany D-01307 , Klin Viszeral Thorax & Gefas Tech,Univ Dresden, Klinikum Carl Gustav Carus, Inst Pathol, D-01307 Dresden Tech Univ Dresden Dresden Germany D-01307 , Inst Pathol, D-01307 Dresden
Titolo Testata:
DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT
fascicolo: 9, volume: 124, anno: 1999,
pagine: 248 - 252
Fonte:
ISI
Lingua:
GER
Soggetto:
ISLET-CELL TUMORS; RAT ADIPOCYTES; RECEPTOR; RESISTANCE; NIDDM; HYPERINSULINEMIA; HYPOGLYCEMIA; DIAGNOSIS; PATIENT; MUSCLE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
24
Recensione:
Indirizzi per estratti:
Indirizzo: Wildbrett, J Techselforsch,den, Klinikum Carl Gustav Carus, Inst Poliklin Klin Stoffwech Tech Univ Dresden Fetscherstasse 74 Dresden Germany D-01307
Citazione:
J. Wildbrett et al., "Unusual picture of an insulinoma in type 2 diabetes mellitus with severe obesity", DEUT MED WO, 124(9), 1999, pp. 248-252

Abstract

History and clinical findings: Marked hyperinsulinism was demonstrated in the course of an oral glucose tolerance test (oGTT) in a 63-year-old woman with severe obesity (height 1.59 m, body weight 123 kg, body-mass index 46.4 kg/m(2)). The diabetic metabolic state, first diagnosed 12 years ago, hadbeen replaced by a low plasma glucose level: she often had attacks of ravenous hunger. A reducing diet of 800 kcal had not been tolerated. She had not had any syncopes. She had continually gained weight since puberty, but her weight had remained relatively constant for the past 5 years during whichshe had been treated with L-thyroxine for a diffuse goitre (stage II). Investigations: In the course of an oGTT (75 g glucose) the basal insulin concentration (146 pmol/l) had risen to 1663 pmol/l at SO min. The basal proinsulin level was 50 times normal (66 pmol/l vs. 1.418 pmol/l), while the initial plasma glucose level had fallen from 4.3 mmol/l to 3.8 mmol/l. Spiral computed tomography of the pancreas showed a 3 x 2.5 cm mass in the region of the tail of the pancreas. Treatment and course: At laparoscopy a 4 cm tumor was palpated in the region of the pancreatic tail. Left resection of the pancreas was performed. Histopathological examination of the surgical specimen confirmed an insulinoma. A repeat of oGTT 6 months postoperatively demonstrated a markedly diminished insulin level compared with the preoperative results, as well as a diabetic metabolic state.conclusion: In case of dramatic improvement of diabetes mellitus in an obese patient without drug treatment or weight reduction an insulin-producing tumour should be considered in the differential diagnosis. There may be no typical hypoglycaemic symptoms because of insulin resistance associated with the obesity.

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Documento generato il 17/01/20 alle ore 20:56:40