Clinical characteristics and incidence of glucose metabolism disorders during the follow-up of surgically treated insuli
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ORIGINAL ARTICLE
Clinical characteristics and incidence of glucose metabolism disorders during the follow-up of surgically treated insulinomas João Sérgio Neves 1,2 Luís Teles3 Vanessa Guerreiro1,4 Eva Lau1,4,5 Ana Isabel Oliveira1 Luís Graça6 José Manuel Lopes4,5,7 Paula Freitas1,4,5 Davide Carvalho 1,4,5 ●
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Received: 4 February 2020 / Accepted: 2 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Insulinoma Pancreatic surgery Prediabetes Diabetes ●
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Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02520-0) contains supplementary material, which is available to authorized users. * João Sérgio Neves [email protected] 1
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Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal Department of Internal Medicine, Centro Hospitalar entre Douro e Vouga, Santa Maria da Feira, Portugal
Insulinomas are the most
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