Insulinoma yog ib hom qog nqaij hlav tsis tshua muaj nyob hauv pancreas uas loj hlob los ntawm kev siv cov tshuaj insulin-secreting cells. Nws lub xub ntiag yog qhov ua rau qee zaum muaj mob hnyav hypoglycemia. Feem ntau benign thiab me me, cov qog tsis yog ib txwm yooj yim mus nrhiav. Qhov kev vam meej ntawm kev phais tshem tawm yog siab.

Lus txhais

Ib qho insulinoma yog ib qho qog ntawm lub txiav, hu ua endocrine vim nws ua rau cov tshuaj insulin ntau dhau. Cov tshuaj hypoglycemic no feem ntau yog tsim los ntawm kev tswj hwm los ntawm cov chav kawm ntawm cov hlwb hauv pancreas, beta hlwb, kom txo cov ntshav qabzib thaum lawv nce siab. Tab sis qhov tso tawm ntawm insulin los ntawm cov qog tsis tswj hwm, uas ua rau lub sijhawm hu ua "functional" hypoglycemia hauv cov neeg laus noj qab haus huv, tsis muaj ntshav qab zib.

Kwv yees li 90% ntawm cov insulinomas yog cov qog nqaij hlav benign. Ib qho me me sib haum mus rau ntau yam thiab / lossis cov qog nqaij hlav - qhov kawg yog qhov txawv ntawm qhov tshwm sim ntawm metastases.

Cov qog no feem ntau me me: cuaj ntawm kaum tsis tshaj 2 cm, thiab peb ntawm kaum yog tsawg dua 1 cm.

Ua rau

Feem ntau ntawm cov insulinomas tshwm sim ib ntus, tsis muaj qhov qhia tau tias yog vim li cas. Nyob rau hauv tsawg zaus, muaj feem cuam tshuam nrog.

diagnostic

Lub xub ntiag ntawm insulinoma yuav tsum raug txiav txim siab thaum tus neeg mob tsis muaj ntshav qab zib muaj cov tsos mob ntawm qhov rov tshwm sim ntawm hypoglycemia yam tsis muaj lwm yam ua rau pom tseeb (kev haus dej cawv, raum, mob siab lossis adrenal tsis txaus, tshuaj, thiab lwm yam).

Insulinoma yog tshwm sim los ntawm cov ntshav qabzib qis heev ua ke nrog cov tshuaj insulin siab. Txhawm rau ua kom pom qhov no, peb xyaum ntsuas kev yoo mov ntev tshaj 72 teev nyob rau hauv kev saib xyuas kev kho mob. Kev kuaj mob yog nyob ntawm kev kuaj ntshav thaum cov tsos mob ntawm hypoglycemia tshwm sim. Qhov kev sim no raug tso tseg sai li sai tau thaum cov ntshav qabzib poob qis dhau lawm.

Tom qab ntawd cov kev kuaj pom yog ua kom pom cov insulinoma. Kev tshuaj ntsuam xyuas yog echo-endoscopy, uas tso cai rau kev tshawb fawb meej ntawm cov txiav txiav siv lub raj hloov tau haum nrog lub koob yees duab thiab ib qho me me ultrasound sojntsuam, nkag mus rau hauv lub plab zom mov los ntawm lub qhov ncauj. Lwm yam kev sim xws li angio-scanner tuaj yeem pab tau.

Txawm hais tias muaj kev nce qib hauv cov duab, nrhiav cov qog me me tseem nyuaj. Nws yog qee zaum ua tiav tom qab tshawb xyuas kev phais ua tsaug rau palpation ua ke nrog kev ua haujlwm hauv ultrasound, siv ib qho kev sojntsuam ultrasound.

Cov neeg txhawj xeeb

Txawm hais tias yog qhov ua rau mob qog nqaij hlav hypoglycemia feem ntau hauv cov neeg laus, insulinoma tseem yog cov qog tsis tshua muaj, cuam tshuam rau 1 txog 2 tus neeg ib lab tus neeg nyob hauv (50 txog 100 tus neeg mob tshiab txhua xyoo hauv Fab Kis).

Kev kuaj mob feem ntau tshwm sim thaum muaj hnub nyoog 50. Qee tus kws sau ntawv sau tseg tias muaj poj niam me ntsis.

Risk yam tseem ceeb

Tsis tshua muaj, insulinoma yog txuam nrog hom 1 ntau yam endocrine neoplasia, ib qho tsis tshua muaj tshwm sim los ntawm cov qog nqaij hlav hauv ntau cov qog endocrine. Ib feem peb ntawm cov insulinomas no yog malignant. Qhov kev pheej hmoo ntawm kev tsim cov tshuaj insulinoma kuj tseem cuam tshuam rau qhov tsawg dua nrog lwm cov kab mob ntawm cov kab mob (von Hippel Lindau kab mob, Recklinghausen neurofibromatosis thiab Bourneville tuberous sclerosis).

Cov ntu ntawm qhov mob hnyav heev feem ntau tshwm sim - tab sis tsis ua haujlwm - thaum sawv ntxov ntawm lub plab khoob lossis tom qab qoj ib ce.

Kev cuam tshuam rau lub paj hlwb ntawm glucose deficiency 

Cov tsos mob muaj xws li tsis muaj zog thiab tsis xis nyob nrog lossis tsis nco qab, mob taub hau, pom kev cuam tshuam, rhiab heev, kev txawj tsav tsheb lossis kev sib koom tes, kev tshaib kev nqhis ... Qee cov tsos mob xws li kev tsis meej pem lossis kev ntxhov siab hauv kev xav, tus cwj pwm lossis kev coj cwj pwm tuaj yeem sim ua rau kev puas siab puas ntsws lossis paj hlwb, uas cuam tshuam rau kev kuaj mob. .

Noj cov tshuaj hypoglycemic

Hauv qhov mob hnyav tshaj plaws, hypoglycemia ua rau muaj qhov pib tshwm sim tsis nco qab, ntau dua lossis tsawg dua thiab feem ntau nrog los ntawm kev tawm hws ntau.

Lwm cov tsos mob

Cov tsos mob no feem ntau cuam tshuam nrog cov cim qhia ntawm cov tshuaj tiv thaiv autonomic rau hypoglycemia:

• kev ntxhov siab, tshee
• xeev siab,
• kev xav ntawm tshav kub thiab tawm hws,
• pallor,
• tachychardie…

   

Kev rov ua dua ntawm hypoglycemia tuaj yeem ua rau hnyav nce.

Kev phais tshem tawm ntawm insulinoma muab cov txiaj ntsig zoo heev (kho tus nqi ntawm 90%).

Thaum lub qog yog ib leeg thiab zoo nyob hauv zos, qhov kev cuam tshuam tuaj yeem raug tsom heev (enucleation) thiab kev phais me me yog qee zaum txaus. Yog tias qhov chaw tsis meej lossis nyob rau hauv qhov xwm txheej ntawm ntau cov qog, nws tseem tuaj yeem ua ib feem ntawm kev tshem tawm ntawm tus txiav (pancreatectomy).

Ntshav qab zib tswj

Thaum tos kev phais lossis yog tias cov tsos mob tshwm sim tom qab phais, cov tshuaj xws li diazoxide lossis somatostatin analogues tuaj yeem pab tiv thaiv cov ntshav qab zib kom tsis txhob poob ntau dhau.

Tau ntsib nrog qhov ua tsis tau zoo, cov tsos mob lossis kev mob qog noj ntshav insulinoma, ntau yam kev kho mob qog noj ntshav tuaj yeem siv tau:

• Tshuaj kho mob yuav tsum tau txiav txim siab kom txo tau cov qog loj.
• Everolimus, tus neeg sawv cev tiv thaiv kab mob tiv thaiv kab mob, tuaj yeem pab tau yog tias muaj kev pheej hmoo ntawm hypoglycemia.
• Kev siv hluav taws xob hauv hluav taws xob siv hluav taws xob siv cov khoom siv hluav taws xob uas tswj hwm los ntawm venous lossis qhov ncauj txoj hauv kev, uas nyiam khi rau cov qog nqaij hlav cancer los ua kom puas. Nws yog tshwj tseg rau cov qog uas qhia ob peb cov pob txha metastases thiab / lossis kev loj hlob qeeb.