scholarly journals SUN-903 Insulinoma - a Tricker Diagnosis When Some Pieces Are Missing

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Manuel Silva
Keyword(s):  
Glucose Level ◽  
Neuroendocrine Tumour ◽  
Clonic Seizure ◽  
Positive Staining ◽  
Normal Range ◽  
Blood Tests ◽  
Fasting Glycemia ◽  
Hypervascular Lesion ◽  
Abdominal Mri ◽  
Surgical History

Abstract Insulinoma is a rare pancreatic neuroendocrine tumour that secretes insulin, causing hypoglycemia. Because of the nonspecific symptoms, the diagnosis could constitute a challenge. Early detection is important to prevent serious consequences. A 31-year old woman was admitted for prolonged fasting test. She had no relevant past medical or surgical history till eight months before, when she had an episode of generalized tonic-clonic seizure with loss of consciousness. At this time, she was taken to emergency, with identification of a hypoglycaemia of 33 mg/dL. Unfortunately this was undervalued and she was discharged with an appointment on a neurologist. After evaluation, she did an EEG, which was normal, and blood tests that identified a fasting glycemia of 50 mg/dL. By recommendation of her general practitioner, she began to monitor her glycemia during the day, identifying multiple glycemia <50mg/dL – in fasting and post-prandial period. After the first generalized seizure, she had multiple seizures, always associated with hypoglycaemia. During the night she had to wake up every two hours to eat, in order to prevent hypoglycaemia. Moreover, in the last 6 months, she augmented 12 Kg. She also described two episodes of behavioural changes with confusion and speech alteration. She wasn’t under any medication that could be associated with hypoglycemias. Previous records showed she had a fasting glycemia of 50 mg/dL two years ago. When she was admitted to our department, besides she had eat one hour before, she had glycemia <55 mg/dL. Blood tests showed glucose level=22 mg/dL, insulin=39 μU/mL (normal range 2.6-24.9 μU/mL), C-Pep=0.90 ng/mL (normal range 1.1-4-4 ng/mL). Plasma B-hydroxybutyrate was negative. After Glucagon EV, glucose level increase to 53 mg/dL (>25 mg/dL). We also evaluated cortisol and growth hormone that were normal. Abdominal computed tomography scan with contrast demonstrated a well-defined hypervascular lesion involving pancreas tail. Abdominal MRI was also performed showing a hypervascular lesion involving pancreas tail with 11x21mm. Laparoscopic surgery to enucleate the lesion was made. Pathological evaluation revealed a well-differentiated neuroendocrine tumour (positive staining for synaptophysin, cromogranin and insulin) measuring 0.3 cm. The diagnosis of pancreatic insulinoma was confirmed. After surgery, the glucose level increased to the normal range. The patient is currently in 6 months follow-up with a good evolution. The diagnosis of insulinoma requires high suspicion. In this case, the patient didn’t have the typical insidious neurogenic symptoms. There is a need to value neuroglycopenic symptoms associated with hypoglycemia, otherwise serious consequences can occur.

Palliative Treatment of Hyperinsulinism With Cyproheptadine and Diazoxide

PEDIATRICS ◽  
1992 ◽  
Vol 90 (2) ◽  
pp. 212-215
Author(s):  
Deborah Rotenstein ◽  
Scott Serbin ◽  
Terra Welsh
Keyword(s):  
Glucose Level ◽  
Combination Treatment ◽  
Palliative Treatment ◽  
Neonatal Period ◽  
Insulin Level ◽  
Treatment Modalities ◽  
Normal Range ◽  
C Peptide ◽  
Level Of Consciousness ◽  
In Infants And Children

Treatment for hyperinsulinism in infants and children can be difficult and has included numerous treatment modalities. This paper reports 16 months of palliative treatment with cyproheptadine and diazoxide in a child with hyperinsulinism initially diagnosed at 6 months of age (her insulin level was 80 µU/mL while her glucose level was 38 mg/dL). She continued to have episodes of staring and alteration in level of consciousness while receiving her usual doses of diazoxide (12 mg/kg) alone. Mean nocturnal glucose values, which were quite low during treatment with diazoxide alone, improved significantly with the addition of cyproheptadine to her therapeutic regimen. Fasted C-peptide values, elevated during diazoxide alone, returned to the normal range with combination treatment for 16 months. Cyproheptadine and diazoxide in combination may be useful for treatment of hyperinsulinism that presents after the neonatal period.

The evaluation of the agreement between fasting glycemia at the first prenatal visit and the results of the glucose tolerance test in diagnostics of gestational diabetes mellitus

2014 ◽  
Vol 60 (5) ◽  
pp. 9-14 ◽  
Author(s):  
P V Popova ◽  
A V Dronova ◽  
E R Sadikova ◽  
M P Parkkinen ◽  
M V Bol’shakova ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Glucose Tolerance Test ◽  
Fasting Blood Glucose ◽  
Tolerance Test ◽  
Fasting Blood Glucose Level ◽  
Prenatal Visit ◽  
Fasting Glycemia ◽  
The Mean

Objective. To evaluate the importance of determining fasting glycemia at the first prenatal visit for timely diagnostics of gesta- tional diabetes mellitus (GDM). Material and methods. The study included 577 pregnant women examined with the use of the oral glucose tolerance test (OGTT) during weeks 24-28 of pregnancy. The results of the test were compared with the fasting glucose level at the first prenatal visit. Results. The mean fasting blood glucose level at the first prenatal visit was 4.70±0.61 mmol/l. In 25% of the patients, fasting glycemia at this time was 5.1 mmol/l or higher. Only in 36% of the women (52 of the145 ones) with the fasting blood glucose level ≥5.1 and <7 mmol/l at the first prenatal visit, the results of OGTT were consistent with the criteria for GDM. The mean fasting blood glucose level at the first prenatal visit (up to week 16) was significantly higher than on weeks 24-28 (4.71±0.61 and 4.53±0.69 mmol/l respectively, p<0.001). The ROC analysis failed to reveal the fasting blood glucose level that could be used to predict the development of gestational diabetes with a reliable sensitivity and specific- ity. Conclusion. Further population-based investigations are needed to elucidate the relationship between fasting glycemia in the first trimester of pregnancy and its unfavourable outcome.

Phosphatemic Control during Acute Renal Failure: Intermittent Hemodialysis versus Continuous Hemodiafiltration

2001 ◽  
Vol 24 (4) ◽  
pp. 186-191 ◽  
Author(s):  
H.K. Tan ◽  
R. Bellomo ◽  
D.A. M'Pisi ◽  
C. Ronco
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Normal Serum ◽  
Serum Phosphate ◽  
Phosphate Concentration ◽  
Intermittent Hemodialysis ◽  
Normal Range ◽  
Continuous Hemodiafiltration ◽  
Intensive Care Patients ◽  
Blood Tests

Background Achieving “adequacy of dialysis” includes the maintenance of normal serum phosphate concentrations and is an important therapeutic goal in the treatment of acute renal failure (ARF). It is unknown whether this goal is best achieved with intermittent or continuous renal replacement therapy. Methods We compared the effects of continuous veno-venous hemodiafiltration (CVVHDF) and intermittent hemodialysis (IHD) on serum phosphate concentrations using daily morning blood tests in 88 consecutive intensive care patients half of which were treated with IHD and half with CRRT. Results Mean patient age was 54 ± 14 years for IHD and 60 ± 14 years for CVVHDF (NS). However, patients who received CVVHDF were more critically ill (mean APACHE II scores: 24.4 ± 5.1 for IHD vs. 29.2 ± 5.7 for CVVHDF, p<0.003). Before treatment, the serum phosphate concentration was 2.04 ± 0.16 mmoll L for IHD and 1.96 ± 0.17 mmoll L for CVVHDF (NS), with abnormal values in 79.4% of IHD patients and in 64.8% of CVVHDF patients (NS). During treatment, CVVHDF induced a greater reduction in serum phosphate (p=0.02) during the first 48 hours and conferred superior subsequent control of hyperphosphatemia (achieved in 64.6% of observations during CVVHDF vs. 41.8% during IHD; p<0.0001). The serum phosphate concentration was also more likely to be within the normal range during CVVHDF (55.3% vs.36.2%; p<0.0001). There was a trend toward more frequent hypophosphatemia (9.3% vs. 5.6%; P<0.1) during CVVHDF. Conclusions Abnormal serum phosphate concentrations are frequent in ARF patients before and during renal replacement, however, normalization of phosphatemia is achieved more frequently with CVVHDF.

scholarly journals Effect of Baluran Gum Arabic on Blood Glucose Level in Diabetic Rat (Rattus Novergicus )

2021 ◽  
Vol 9 (2) ◽  
pp. 81
Author(s):  
Hidayat Teguh Wiyono ◽  
Eva Tyas Utami ◽  
Dinna Wahyu Putri Wardhani
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Gum Arabic ◽  
Diabetic Rat ◽  
Control Group ◽  
Normal Range ◽  
Reduce Blood Glucose ◽  
Reduce Blood Glucose Level

Diabetes mellitus is a metabolic disease which indicated with increasing blood glucose level. Carbohidrate, protein, mineral and secondary metabolite (alkaloid, tannin and saponin) can be benefical to treat diabetes mellitus. Rats were randomly divided into three groups. First, control group. Second, STZ group, untreated diabetic. Third, STZ+GA 15% group, diabetic treated with GA 15%. Result showed that blood glucose level before STZ induction on control and STZ group within normal range 78,57±11,90 mg/dL and 74,85±6,86 mg/dL. Blood glucose level significantly increase after STZ induction on STZ and STZ+GA 15% group become 375±6,53 mg/dL and 346,42±50,23 mg/dL. Diabetic rat treated with GA 15% revealed decrease in blood glucose level compared to untreated diabetic rat. Blood glucose level on STZ+GA 15% group continuously decrease become 96,42±13,45 mg/dL and 82,14±9,19 mg/dL. In conclusion, GA 15% could reduce blood glucose level on diabetic rat.

The Relevance of Blood Tests in the Management of Thromboembolism

1979 ◽  
Author(s):  
Hymie L. Nossel
Keyword(s):  
Pulmonary Embolism ◽  
Quantitative Information ◽  
Diagnostic Techniques ◽  
Fibrinopeptide A ◽  
Normal Range ◽  
New Techniques ◽  
Blood Tests ◽  
Biochemical Event ◽  
Intravenous Heparin ◽  
Lung Scan

Fibrinopeptide A (FPA) levels reflect fibrin I formed by thrombin proteolysis of fibrinogen - a single biochemical event in fibrin formation and thrombosis. Studies in symptomatic patients suspected of venous thromboembolism (TE) demonstrated a good correlation in 40/45 patients between elevated FPA levels and the presence of thrombosis and/or pulmonary embolism indicated by venogram and/or lung scan and in 50/55 patients between normal FPA levels and the absence of TE. Within 15 minutes of intravenous heparin in 30 patients with documented TE, FPA levels had reached the normal range. In 3 of 17 patients studied over 10 days of anticoagulant therapy elevated FPA levels were associated with recurrence or extension of embolism. Thus, plasma FPA measurements may be useful in the diagnosis and management of venous TE. A second biochemical event - fragment X formation by plasmin cleavage of the Aα and N-terminal Bऔ chains of fibrinogen - can be monitored as thrombinincreasable fibrinopeptide B immunoreactivity. Initial studies suggest imbalance between thrombin and plasmin action favoring thrombin during the inception of thrombosis and favoring plasmin during resolution. The use of these tests is providing specific and quantitative information concerning biochemical reactions associated with clinical TE. In correlation with 125I-fibrinogen scanning and conventional diagnostic techniques, these tests will provide basic pathophysiological understanding which will facilitate the development and use of new techniques in diagnosis, prediction and management of venous TE.

scholarly journals Primary Peritoneal Serous Carcinoma Detected by Abnormal Cervical Smear: a Case Report

Folia Medica ◽  
2020 ◽  
Vol 62 (1) ◽  
pp. 195-199
Author(s):  
Nikolaos Blontzos ◽  
Christos Iavazzo ◽  
Eirini Giovannopoulou ◽  
George Galanopoulos ◽  
Victoria Psomiadou ◽  
...  
Keyword(s):  
Pap Smear ◽  
Ovarian Tissue ◽  
Serous Carcinoma ◽  
Cervical Smear ◽  
Peritoneal Cancer ◽  
Endometrial Tumor ◽  
Abdominal Mri ◽  
Surgical History ◽  
History Of ◽  
Rare Malignancy

Primary peritoneal serous carcinoma (PPSC) is a rare malignancy, the clinical characteristics of which resemble ovarian serous carcinoma. We present a rare case of PPSC detected by an abnormal cervical smear, the first one with an absence of ovarian tissue at the time of the initial diagnosis. A 59-year-old asymptomatic woman presented with glandular atypia on routine Papanicolaou smear. Endocervical and endometrial curettage showed an adenocarcinoma with focal squamous differentiation and uncertain further classification. The patient had a past surgical history of bilateral salpingoophorectomy due to endometriosis. Abdominal MRI depicted omental multinodularity, great amount of ascites and possible endometrial tumor. The patient underwent total hysterectomy, omentectomy and biopsies of implants on Douglass pouch. &nbsp;Surgical and histological findings were consistent with primary peritoneal serous carcinoma.&nbsp; Abnormal pap smear could rarely be suggestive of extrauterine malignancies, such as peritoneal cancer.

Severe hypophosphataemia following oral bisphosphonate treatment in a patient with osteoporosis

2020 ◽  
Vol 13 (10) ◽  
pp. e235083 ◽  
Author(s):  
Louise Wulff Bagger ◽  
Per Kim Dyhr Hansen ◽  
Peter Schwarz ◽  
Barbara Rubek Nielsen
Keyword(s):  
Emergency Department ◽  
Bisphosphonate Treatment ◽  
Normal Range ◽  
Hydroxyvitamin D ◽  
Blood Tests ◽  
Routine Blood ◽  
Oral Bisphosphonate ◽  
Ionised Calcium ◽  
25 Hydroxyvitamin D ◽  
Difficulty Walking

A 76-year-old woman was treated with oral bisphosphonate, alendronate, for osteoporosis in an outpatient clinic. Routine blood tests 4 months after alendronate prescription surprisingly revealed severe hypophosphataemia. The patient was hospitalised and treated with intravenous and oral phosphate supplements. Alendronate was later reintroduced as treatment for osteoporosis and the patient once again presented with severe hypophosphataemia in subsequent routine blood tests. The patient had only presented with lower extremity pain, muscle weakness and difficulty walking. Blood tests in the emergency department both times reconfirmed severe hypophosphataemia. Plasma (p-)ionised calcium levels were normal or slightly elevated and p-parathyroid hormone levels were normal or slightly suppressed. The p-25-hydroxyvitamin-D and p-creatine were in the normal range. Critical illness, malabsorption, nutritional issues and genetics were reviewed as potential causes but considered unlikely. Phosphate levels were quickly restored each time on replacement therapy and the case was interpreted as bisphosphonate-induced severe hypophosphataemia.

REPORT CASE STUDY AND REVEIW LITERATURE: A BENIGN MYOEPITHELIOMA OF THE LUNG

2017 ◽  
pp. 115-118
Author(s):  
Thanh Tuan Phan ◽  
The Quan Ngo
Keyword(s):  
S100 Protein ◽  
Chest Ct ◽  
Lung Nodules ◽  
Ct Scanner ◽  
Normal Range ◽  
Blood Tests ◽  
Pulmonary Tumor ◽  
Spindle Cells ◽  
The World

Introduction: Benign myoepithelioma is extremely rare tumor in the lung, there are little cases having been reported in the literature in all over the world, and no report in Vietnam. Case report: A 33-years woman have fever and dry cough from 6 months before entering the hospital, she were treated at home, her fever was gone but the coughing isnot stop, and increasing dyspnea and chest pain. The blood tests is almost in the normal range. Chest CT-scanner showed the tumor in the central bronchial tubes, endoscopy was defined the tumor made the obstruction for the caliber of the left bronchial and designated to remove it by bronchialendoscopy. Histologically, there was mixed of spindle cells, plasmocytoid cells, epithelial cell and clear cells. No mitotic activity or necrosis was seen. Immuhistochemically, the tumor cells positive for EMA, VIII factor, vimentine, and S100 protein. They were negatives for cytokeratine, desmin, CD31, CD34 and GFAP. The diagnosis was benign myoepithelioma of the lung. The patient recovered well after surgery. Conclusion: Benign myoepithelioma is a rare pulmonary tumor, used to differentiate when diagnosing for single lung nodules. This tumor usually distinct from pleomorphic adenoma. Key words: Benign myoepithelioma, lung, lung nodules

scholarly journals An Unusual Location of Neuroendocrine Tumour: Primary Hepatic Origin

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
A. Bahar Ceyran ◽  
A. Tarık Artış ◽  
Serkan Şenol ◽  
Bengü Çobanoğlu Şimşek
Keyword(s):  
Liver Biopsy ◽  
Histopathological Examination ◽  
Neuroendocrine Tumour ◽  
Primary Tumour ◽  
Abdominal Ultrasound ◽  
Positive Staining ◽  
Morphologic Characteristics ◽  
Resected Liver ◽  
S 100 ◽  
Lower Endoscopy

Although neuroendocrine tumours (NETs) of primary hepatic origin are extremely rare, most of NETs present with liver metastasis. When a NET is found in the liver, it must be treated to exclude metastasis from extrahepatic primary sites. The patient was a 38-year-old female. Abdominal ultrasound showed an 8 cm tumour in liver during a routine examination. Liver biopsy was done. The tumour was first considered a metastatic hepatic tumour on histopathological examination. No clues to the origin of a primary tumour were found. Upper and lower endoscopy of the GI tract and chest CT were performed to search for a primary tumour and were negative for any tumour. One month later, more extensive areas of the tumour were seen on histopathological examination of second liver biopsy with the same morphologic characteristics as the first biopsy. Immunohistochemically, there was positive staining for synaptophysin, CD 56, and S-100 in the tumour cells. These findings suggested the diagnosis of NET. The diagnosis of primary liver NET was considered in a multidisciplinary meeting. Then, left hepatectomy was performed. The final pathologic diagnosis of the tumour in the resected liver specimen was Grade II NET. The patient was doing well at postoperative 28-month follow-up.

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