Kaohsiung Journal of Medical Sciences
Volume 23, Issue 10 , Pages 526-530 , October 2007

Insulinoma-associated Transient Hypothalamus—Pituitary—Adrenal Axis Impairment and Amelioration by Steroid Therapy and Surgical Intervention: A Case Report

  • Yu-Hung Chang

      Affiliations

    • Department of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  • ,
  • Ming-Chia Hsieh

      Affiliations

    • Department of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  • ,
  • Shih-Chieh Hsin

      Affiliations

    • Department of Endocrinology and Metabolism, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
  • ,
  • Shyi-Jang Shin

      Affiliations

    • Department of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  • ,
  • Kun-Der Lin

      Affiliations

    • Department of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Kun-Der Lin, Department of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, 100 Shin-Chuan 1st Road, Kaohsiung 807, Taiwan

Received 24 November 2006 ,Accepted 12 January 2007.

References 

  1. Service FJ , McMahon MM , O'Brien PC , et al.   Functioning insulinoma—incidence, recurrence, and long-term survival of patients: a 60-year study . Mayo Clin Proc . 1991;66:711–719
  2. Doherty GM , Doppman JL , Shawker TH , et al.   Results of a prospective strategy to diagnose, localize, and resect insulinomas . Surgery . 1991;110:989–997
  3. Pasieka JL , McLeod MK , Thompson NW , et al.   Surgical approach to insulinomas. Assessing the need for preoperative localization . Arch Surg . 1992;127:442–447
  4. Grama D , Eriksson B , Martensson H , et al.   Clinical characteristics, treatment and survival in patients with pancreatic tumors causing hormonal syndromes . World J Surg . 1992;16:632–639
  5. Menegaux F , Schmitt G , Mercadier M , et al.   Pancreatic insulinomas . Am J Surg . 1993;165:243–248
  6. Thompson NW , Eckhauser FE . Malignant islet-cell tumors of the pancreas . World J Surg . 1984;8:940–951
  7. Buetow PC , Parrino TV , Buck JL , et al.   Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status . AJR Am J Roentgenol . 1995;165:1175–1179
  8. Grant CS . Insulinoma . Best Pract Res Clin Gastroenterol . 2005;19:783–798
  9. Thoeni RF , Mueller-Lisse UG , Chan R , et al.   Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal sensitivity . Radiology . 2000;214:483–490
  10. Hirshberg B , Libutti SK , Alexander HR , et al.   Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure . J Am Coll Surg . 2002;194:761–764
  11. Kaplan EL , Rubenstein AH , Evans R , et al.   Calcium infusion: a new provocative test for insulinomas . Ann Surg . 1979;190:501–507
  12. Doppman JL , Chang R , Fraker DL , et al.   Localization of insulinomas to regions of the pancreas by intraarterial stimulation with calcium . Ann Intern Med . 1995;123:269–273
  13. McAuley G , Delaney H , Colville J , et al.   Multimodality preoperative imaging of pancreatic insulinomas . Clin Radiol . 2005;60:1039–1050
  14. Pereira PL , Wiskirchen J . Morphological and functional investigations of neuroendocrine tumors of the pancreas . Eur Radiol . 2003;13:2133–2146
  15. Chiti A , Fanti S , Savelli G , et al.   Comparison of somatostatin receptor imaging, computed tomography and ultrasound in the clinical management of neuroendocrine gastro-entero-pancreatic tumours . Eur J Nucl Med . 1998;25:1396–1403
  16. Cryer PE . Mechanisms of hypoglycemia-associated autonomic failure and its component syndromes in diabetes . Diabetes . 2005;54:3592–3601
  17. Davis SN , Shavers C , Costa F , et al.   Role of cortisol in the pathogenesis of deficient counterregulation after antecedent hypoglycemia in normal humans . J Clin Invest . 1996;98:680–691
  18. Davis SN , Shavers C , Davis B , et al.   Prevention of an increase in plasma cortisol during hypoglycemia preserves subsequent counterregulatory responses . J Clin Invest . 1997;100:429–438
  19. McGregor VP , Banarer S , Cryer PE . Elevated endogenous cortisol reduces autonomic neuroendocrine and symptom responses to subsequent hypoglycemia . Am J Physiol Endocrinol Metab . 2002;282:770–777
  20. Raju B , McGregor VP , Cryer PE . Cortisol elevations comparable to those that occur during hypoglycemia do not cause hypoglycemia-associated autonomic failure . Diabetes . 2003;52:2083–2089
  21. Spyer G , Hattersley AT , MacDonald IA , et al.   Hypo-glycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type 2 diabetes . Lancet . 2000;356:1970–1974
  22. Scott LV , Medbak S , Dinan TG . ACTH and cortisol release following intravenous desmopressin: a dose-response study . Clin Endocrinol (Oxf) . 1999;51:653–658
  23. Mitrakou A , Fanelli C , Veneman T , et al.   Reversibility of unawareness of hypoglycemia in patients with insulinomas . N Engl J Med . 1993;329:834–839

PII: S1607-551X(08)70011-1

doi: 10.1016/S1607-551X(08)70011-1

Kaohsiung Journal of Medical Sciences
Volume 23, Issue 10 , Pages 526-530 , October 2007