Thousands of people have starved to death in the world because of lack of food and drink. However, because of greed and eating for a long time, it is rare to eat and die.
One day from the field, a big fat man in his thirties was born with a weight of 160 kilograms. From the outside, it is very similar to the Japanese sumo athletes, but he is slow to move and he cannot stand alone. Because of the fear that the spring of the bed could not withstand his weight, he had to replace it with a reinforced wooden bed. Don't look at his obesity now. In fact, he was only seventy kilograms six months ago. He is a handsome man. Since he got the "greed", his appetite is getting bigger and bigger. In addition to three meals, he also likes to eat snacks, especially eating "dry goods" such as biscuits and bread. Later, when I developed to the night, I would be hungry, and I would have to eat a few nightingales in the middle of the night. And its weight has soared, but its physical strength has plummeted. Recently developed to one hour during the day without eating will faint, you must wake up in time to inject glucose. The local hospital was diagnosed with hypoglycemia, but he was unable to do anything about it. He had to go to a general hospital in a big city.
What is hypoglycemia? Hypoglycemia is a syndrome caused by a group of multiple causes with a low concentration of venous plasma glucose, clinically characterized by sympathetic excitation and brain cell hypoglycemia. According to the traditional Whipple triad, the venous plasma glucose concentration is generally lower than 2.8 mmol/L (50 mg/dl) as the standard for hypoglycemia. Clinically, the relationship between the occurrence of hypoglycemia and eating is divided into fasting (post-absorption) hypoglycemia and postprandial (reactive) hypoglycemia. The main cause of fasting hypoglycemia is inappropriate hyperinsulinemia, and postprandial hypoglycemia is excessively reactive with insulin. Repeated fasting hypoglycemia in the clinic suggests organic diseases, and reactive hypoglycemia caused after meals is more common in functional diseases. Some organic diseases (such as insulinoma) are mainly fasting hypoglycemia, but there may also be postprandial hypoglycemia. After the fat man came to our hospital, we checked him blood sugar, 2.5mmol / L, less than 2.8mmol / L, in line with the diagnosis of hypoglycemia
The cause of the fat man was quickly identified as "islet cell tumor", which is a malignant tumor. I was supposed to have surgery for him, but it was too late, and the results had not yet had time for surgery, and I died of heart failure because my heart was overwhelmed. At this time, the weight was 182 kilograms, and the body was lifted into the morgue by six strong men.
Islet cell tumor is also called pancreatic beta cell tumor. The hormone secreted by islet cells is called insulin. The main role of this hormone is to help convert glucose in the blood into glycogen and fat, participate in energy metabolism in the body, and regulate blood sugar to maintain a certain level. Diabetic people are because the total amount of insulin secreted by islet cells is insufficient or relatively insufficient, and the glucose in the blood cannot be converted in time to cause hyperglycemia. Therefore, people with diabetes should limit foods with high energy intake, especially sugar foods. This fat man's situation is the opposite, due to islet cell malignant hyperplasia, excessive insulin secretion, a large amount of blood sugar, resulting in hypoglycemia and even shock, only timely injection of glucose or timely eating, can barely maintain blood sugar levels. However, the fat that is converted from blood sugar is accumulating more and more, and the weight is soared. What is more, the fat is deposited in the heart, liver and other internal organs and chest and abdomen, which hinders normal physiological functions. Eventually dragging the heart leads to death. Insulinoma is the most common in functional pancreatic endocrine tumors. Women are slightly more than males. The high-risk age is 40-50 years old. Most of them are benign single hair, small in size and generally 1-2 cm in diameter.
Insulinoma is the most common cause of organic hypoglycemia, with islet R cell adenoma accounting for approximately 84% (90% for single adenoma, 10% for multiple adenoma), followed by adenocarcinoma, diffuse islet p Cell proliferation is rare. Most of the tumors are located in the pancreas. The distribution of pancreatic head, pancreatic body and pancreatic tail is basically equal. The incidence rate of female is higher than that of male; the ectopic is rare. Insulinoma can be familial and can coexist with parathyroid adenomas and pituitary tumors (multiple endocrine neoplasia type I, MEN-1). Individual insulinomas also secrete gastrin, glucagon, ACTH, somatostatin and the like. CT, MRI, selective pancreatic angiography, and endoscopic ultrasonography contribute to the localization of the tumor, preferably by intraoperative ultrasound and manual exploration.
The first symptom of insulinoma is hypoglycemia. Most patients may not be diagnosed when hypoglycemia occurs for the first time. The average misdiagnosis time is 3 years. When a patient has hypoglycemia, he often has headaches, blurred vision, inconsistent thinking, and forgetfulness. In addition, patients may also have epilepsy, ataxia, speech and autonomous dyskinesia, the most serious manifestation is coma. Other clinical symptoms of insulinoma depend on the state of the autonomic nervous system. Hypoglycemia caused by stress leads to the release of catecholamines. The sympathetic adrenal response causes hyperhidrosis, collapse, palpitations, tremors, fear and anxiety. Regular meals can alleviate neuroglycopeptide symptoms and sympathetic adrenal symptoms, so patients with insulinoma often add meals at night to avoid hypoglycemia, resulting in a rapid increase in weight in the short term.
(1) The diagnosis of insulinoma mainly includes two aspects.
1. Qualitative diagnosis.
The traditional Whipple triad summarizes the clinical manifestations and diagnostic points of insulinoma. This triad includes: symptoms of hypoglycemia after fasting or exercise, blood glucose below 2.8mmol / L (50 mg / dl) when symptoms occur, feeding or intravenous bolus glucose can quickly relieve symptoms. In addition, modern diagnostics require the use of radioimmunoassay to detect serum insulin levels and evidence of abnormally elevated insulin levels relative to blood glucose levels. If there is no episode of hypoglycemia, a starvation induction test can be performed. After 24 hours of starvation, a blood insulin/blood sugar (I/G ratio) of more than 0.3 indicates that there is autophagic insulin secretion that is not inhibited by hypoglycemia. The levels of C-peptide and pre-insulin in insulinoma patients are also increased.
2. Positioning diagnosis.
Identify the location, number of tumors, and whether or not to metastasize.
(1) Imaging diagnosis: Preoperative ultrasound or conventional CT examination has limited ability to locate and diagnose. Arterial angiography can find a circularly densely stained image with a clear boundary, that is, a "bulb sign" with a diagnostic rate of 80%.
Pancreatic thin-layer scanning enhanced CT and three-dimensional reconstruction can accurately locate most insulinomas. Conditional units can simultaneously perform pancreatic perfusion scan, which can further improve the localization diagnosis rate of insulinoma.
(2) Percutaneous transhepatic portal vein catheterization for the determination of insulin (PTPS) and selective intra-arterial calcium gluconate challenge test (IACS): segmentation of blood from veins and arteries and determination of insulin content, according to its peak Positioning diagnosis.
(3) Somatostatin receptor imaging: the use of radionuclide-labeled somatostatin to show insulinoma, which is helpful for the detection of multiple lesions and metastases.
(4) intraoperative exploration: accurate localization diagnosis depends on intraoperative exploration after open surgery, especially intraoperative ultrasound. Surgical exploration, palpation combined with intraoperative ultrasound can locate 95%-100% of insulinomas.
(two) treatment
The treatment of insulin tumors includes diet adjustment, in order to minimize the occurrence of hypoglycemia, should be added regularly on time. The radical treatment is surgical removal of the tumor, and the surgical procedure is determined based on the location of the tumor and its relationship to the pancreatic duct. Most tumors can be cured by tumor removal. A tumor located near the main pancreatic duct at the tail of the pancreas is a viable distal pancreatectomy. Pancreaticoduodenectomy can be performed at the uncinate part of the pancreas, multiple tumors, and malignant insulinoma. Most insulinomas are benign, single-shot, small, and intact. In combination with intraoperative ultrasound, laparoscopic insulinoma resection can be considered.
For patients with malignant insulinoma and inoperable patients who cannot completely remove metastases, chemotherapy with streptozotocin combined with 5-fluorouracil or doxorubicin may be used.
If this type of patient is discovered earlier, early surgery and early removal of tumor tissue, it should be said that there is still hope for cure. and so. We should remember: early treatment, do not delay the opportunity.
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