Endocrinology and Metabolism

Case Report

A Case of Insulinoma Localized by Percutaneous Tracshepatic Portal Catheterization with Insulin Hormone Assay.: Byung Jin Kim, Jun Sang Lee, Kyung Seuk Lee, Byung Gyu Park, In Joo Kim, Yong Ki Kim; J Korean Endocr Soc. 1996;11(3):355-361. Published online November 7, 2019

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Abstract PDF: The diagnosis of insulinoma is made primarily by the detection of an inappropriately elevated serum insulin level in the presence of a low blood glucose level. The successful resection of insulin-secreting islet cell turnors is greatly facilitated by accurate preoperative localization. But, the modalities of ultrasonography, computer tomography, magnetic resonance imaging and selective arteriography often fail to detect insulinoma smaller than 1.5 cm in diameter. In this report, we describe a patient with an insulinoma successfully localized by percutaneous transhepatic portal vein sampling but not by abdominal ultrasonography, computer tomography and selective arteriography. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step-up of insulin concentrations near 6 cm from distal splenic vein. During operation, a 1×1.3cm sized tumor was found at the junction of body and tail of pancreas, so distal pancreatectomy was performed, We propose that preoperative percutaneous transhepatic portal vein catheterization with measurement of radioimmunoactive insulin concentration is a safe and reliable method and plays an important role to localize insulinoma that are considered occult after conventional diagnostic studies have been negative.

Original Article

A Case of Insulinoma without Peripheral Hyperinsulinemia.: S W Park, J G Chae, C C Choi, S K Lee, K U Lee, D J Han, I C Lee, K B Sung, S H Kim, Y K Shong, J Y Park, G S Kim; J Korean Endocr Soc. 1995;10(4):434-438. Published online November 7, 2019

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Abstract PDF: Insulinoma is a disorder characterized by hypoglycemia due to endogenous hyperinsulinemia. The elevated plasma insulin level and hypoglycemia should be established for the diagnosis of an insulinoma. Other laboratory methods such as immunoreactive insulin to glucose(IRI/G) ratio, C-peptide, proinsulin, and some provocation tests are also employed to detect an insulinoma because hyperinsulinemia is often not found. Especially, IRI/G ratio has been considered as very sensitive and specific test to confirm the insulinoma without peripheral hyperinsulinemia. We report a case of insulinoma without hyperinsulinemia and elevation of IRI/G ratio, which was diagnosed by endoscopic ultrasonography and THPVS(Transhepatic portal venous sampling). It is suggested that more confirmatory tests will be necessary for the diagnosis of insulinoma especially when it is highly suspected although IRI/G ratio is not increased.

Case Reports

A Case of Malignant Insulinoma Resistant to Octreotide and Combination Chemotherapy.: Duk Kyu Kim, Hyuk Chan Kwon, Ju Il Lee, Do Young Kang, Jae Seok Kim, Hyo Jin Kim, Jong Seong Kim; J Korean Endocr Soc. 1994;10(3):300-305. Published online November 6, 2019

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Abstract PDF: Insulinoma is insulin-secreting tumor that almost all originate in the pancreas and cause symptoms related to hypoglycemia. The documentation of metastatic lesions by imaging studies, is only accurate mean of diagnosing malignant insulinoma before surgical exploration. We experienced a case of malignant insulinoma with liver, adrenal glands, regional lymph nodes and multiple bone metastasis. Abdominal ultrasonography, computed tomography and liver, bone scanning were used to evaluate the disease. Tissue diagnosis was obtained by percutaneous needle biopsy of liver metastasis. The patient was treated with Octreotide therapy and combination chemotherapy(Streptozocin and 5-FU), but she did not respond to these regimen. Now, we present this case with the brief review of literatures.

A Case of Insulinoma Diagnosed as Epilepsy for 7 Years.: Jong Su Kim, Hyung Gyung Choi, Eun Suk Choi, Soo Ryong Jung, Chung Huh, Jin Kwan Lee; J Korean Endocr Soc. 1994;9(3):265-271. Published online November 6, 2019

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Abstract PDF: Insulinoma is rare functioning islet cell tumor of pancreas and its main feature is frequent attacks of hypoglycemia. Because of frequent seizure, the disease is occasionally mistook as epilepy. We experienced a case of insulinoma with dilantin toxicity in a 45 year old patient who had been treated with dilantin for 7 years. Selective splenic arteriogram showed 0.8cm mass in the tail of pancreas which was proven insulin secreting tumor on histiopathological examination. After operation no more seizure attack was detected and her blood sugar level was well maintained within normal range. This case might provide an insight that the possibility of insulinoma should be considered in patient with episodic neurobehavioral dysfunction such as epilepsy.

A Case of Malignant Insulinoma Treated with Streptozotocin after Surgery.: Yun Chang Jun, Byung Hun Lim, Bong Jung Son, Byung Ik Kim, Man Ho Lee, Sang Jong Lee, Won Kil Pae, Myung Suk Kim; J Korean Endocr Soc. 1994;9(2):150-155. Published online November 6, 2019

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Abstract PDF: Insulinoma is clinically characterized by fasting hypoglycemia, various neuropsychiatric symptoms, and these caused by secondary to hypoglycemia.Of patients with insulinoma, 80 percent have single benign tumors, 11 percent have multiple benign tumors, 6 percent have single malignant tumors, and the remainder have multiple malignant tumors or islet hyperplasia according to Service's statement.A 42 year-old male chemical engineer who had insulinoma associated with regional lymph node metastasis has been successfully performed with curative resection and consecutive postoperative therapy with streptozotocin.He entered to this hospital because of frequent occasion of bizarre behavior and language, transient unconsiousness and syncopal episode, and sweating associated with hypoglycemia especially in night four months prior to addmission in November 1992. Those symptoms and hypoglycemia were controlled by intravenous glucose injection and/or oral feeding of glucose riched stuffs.No physical abnormalities were found except neuropsychiatric symptoms. On admission the fasting blood glucose level was 10 mg/dl, plasma immunoreactive plasma insulin level was 125.23 uU/ml, and plasma C-peptide level was 10.24 ng/ml, respectively.Abdominal CT was suggestive of retroperitoneal tumor just behind the pancreas. Selective celiac axis angiography demonstrated hypervascular mass supplied by dorsal pancreatic artery which was compatible with insulinoma. Surgical intervention including distal pancreatectomy, as well as splenectomy and parital omental resection were performed successfully. Consecutive postoperative treatment of streptozotocin was done without any side effects.His condition is very good and enjoyed his life with full activity to date.

Original Article

Obesity and Metabolism
Clinical Implications of Various Criteria for the Biochemical Diagnosis of Insulinoma: Chang Ho Ahn, Lee-Kyung Kim, Jie Eun Lee, Chan-Hyeon Jung, Se-Hee Min, Kyong Soo Park, Seong Yeon Kim, Young Min Cho; Endocrinol Metab. 2014;29(4):498-504. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.498

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Background

Among the various diagnostic criteria for insulinoma, the ratio criteria have been controversial. However, the amended insulin-glucose ratio exhibited excellent diagnostic performance in a recent retrospective cohort study, although it has not yet been validated in other patient cohorts. We examined the diagnostic performance of the current criteria of the Endocrine Society, insulin-glucose ratio, C-peptide-glucose ratio, and amended ratios in terms of differentiating insulinomas.

Methods

We reviewed the medical records of patients who underwent evaluation for hypoglycemia from 2000 to 2013. Fourteen patients with histopathologically confirmed insulinoma and 18 patients without clinical evidence of insulinoma were included. The results of a prolonged fast test were analyzed according to the abovementioned criteria.

Results

Fulfilling all three Endocrine Society criteria-plasma levels of glucose (<3.0 mmol/L), insulin (≥8 pmol/L), and C-peptide (≥0.2 nmol/L)-exhibited 100% sensitivity and 89% specificity. Fulfilling the glucose and C-peptide criteria showed 100% sensitivity and 83% specificity, while fulfilling the glucose and insulin criteria showed 100% sensitivity and 72% specificity. Among the ratio criteria, the insulin-glucose ratio [>24.0 (pmol/L)/(mmol/L)] gave the highest area under the receiver operating characteristic curve, with 93% sensitivity and 94% specificity.

Conclusion

Fulfilling the glucose, insulin, and C-peptide criteria of the Endocrine Society guidelines exhibited the best diagnostic performance for insulinoma. Nonetheless, the insulin-glucose ratio may still have a role in the biochemical diagnosis of insulinoma.

Citations

Citations to this article as recorded by

Homeostasis Model Assessment of β-Cell Function for Diagnosis of Insulinoma
Kálmán Bódis, Martin Schön, Laura Dauben, Miriam Wilker, Klaus Strassburger, Volker Burkart, Michael Roden, Karsten Müssig
The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): e1125. CrossRef
A novel diagnostic model for insulinoma
Feng Wang, Zhe Yang, XiuBing Chen, Yiling Peng, HaiXing Jiang, ShanYu Qin
Discover Oncology.2022;[Epub] CrossRef
Comparison of the diagnostic accuracy of the current guidelines for detecting insulinoma
Laura Dauben, Marie-Christine Simon, Klaus Strassburger, Volker Burkart, Katharina S Weber, Sven Schinner, Michael Roden, Karsten Müssig
European Journal of Endocrinology.2019; 180(6): 381. CrossRef
EUS-guided lauromacrogol ablation of insulinomas: a novel treatment
Shanyu Qin, Yongru Liu, Hongjian Ning, Lin Tao, Wei Luo, Donghong Lu, Zuojie Luo, Yingfen Qin, Jia Zhou, Junqiang Chen, Haixing Jiang
Scandinavian Journal of Gastroenterology.2018; 53(5): 616. CrossRef
Diagnosis of insulinoma using the ratios of serum concentrations of insulin and C-peptide to glucose during a 5-hour oral glucose tolerance test
Xu Li, Feng Zhang, Haibing Chen, Haoyong Yu, Jian Zhou, Ming Li, Qing Li, Lianxi Li, Jun Yin, Fang Liu, Yuqian Bao, Junfeng Han, Weiping Jia
Endocrine Journal.2017; 64(1): 49. CrossRef
Insulinoma in a 5‐Year‐Old Dexter Cow
C. Binici, S. Plog, O. Kershaw, M. Schmicke, J.H. van der Kolk, K.E. Müller
Journal of Veterinary Internal Medicine.2016; 30(4): 1402. CrossRef
Vague neuroglycopenic complaints camouflage diagnosis of adolescent insulinoma: a case report
Kelsee Halpin, Ryan McDonough, Patria Alba, Jared Halpin, Vivekanand Singh, Yun Yan
International Journal of Pediatric Endocrinology.2016;[Epub] CrossRef
Articles in 'Endocrinology and Metabolism' in 2014
Won-Young Lee
Endocrinology and Metabolism.2015; 30(1): 47. CrossRef

Case Reports

Transformation of Nonfunctioning Pancreatic Neuroendocrine Carcinoma Cells into Insulin Producing Cells after Treatment with Sunitinib: Jung Hun Ohn, Yeong Gi Kim, Se-Hoon Lee, Hye Seung Jung; Endocrinol Metab. 2013;28(2):149-152. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.149

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Abstract PDF PubReader

We report a rare case of severe hypoglycemia after sunitinib treatment for pancreatic neuroendocrine carcinoma. We describe the initial clinical presentation, laboratory results, pathologic findings, and managment in a patient with a nonfunctioning pancreatic neuroendocrine carcinoma with liver metastases who developed life threatening hypoglycemia after 2 months of sunitinib therapy. A 46-year-old woman presented to the emergency department with loss of consciousness from hypoglycemia. Serum C-peptide and insulin levels at fasting state revealed that the hypoglycemia resulted from endogenous hyperinsulinemia. She had been diagnosed with nonfunctioning pancreatic neuroendocrine carcinoma based on a biopsy of metastatic cervical lymph node and was being treated with sunitinib, a small molecule tyrosine kinase inhibitor. Immunohistochemical stain of the metastatic liver mass demonstrated that the initially nonfunctioning neuroendocrine carcinoma cells had changed into insulin-producing cells after sunitinib therapy. Transarterial chemoembolization of the liver masses and systemic chemotherapy with streptozotocin/adriamycin relieved the hypoglycemia. A nonfunctioning pancreatic neuroendocrine carcinoma was transformed into an insulin-producing tumor after treatment with sunitinib, causing endogenous hyperinsulinemia and severe hypoglycemia.

Citations

Citations to this article as recorded by

Small Insulinoma Followed-up as an Indolent Pancreatic Tumor: A Case Report
Hiroki Sato, Shozaburo Fujii, Tetsuhiro Okada, Hidemasa Kawabata, Yuki Kamikokura, Mikihiro Fujiya
Internal Medicine.2024;[Epub] CrossRef
A Case of a Metastatic Pancreatic Neuroendocrine Tumor: A Surgical Conundrum Wrapped in Functionality's Embrace
Adam Mylonakis, Michail Vailas, Panagiotis Sakarellos, Lysandros Karydakis, Eleandros Kyros, Spyridon Davakis, Alexandros Papalampros, Evaggelos Felekouras
Cureus.2024;[Epub] CrossRef
Malignant Insulinoma Arising From Nonfunctioning Pancreatic Neuroendocrine Tumor
Ritodhi Chatterjee, Basim Ali, Son H. Nguyen, Rui Chen, Yvonne H. Sada
ACG Case Reports Journal.2023; 10(1): e00954. CrossRef
Case Report: Giant insulinoma, a very rare tumor causing hypoglycemia
Georges Tarris, Alexia Rouland, Kévin Guillen, Romaric Loffroy, Anne-Cécile Lariotte, Patrick Rat, Benjamin Bouillet, Haingo Andrianiaina, Jean-Michel Petit, Laurent Martin
Frontiers in Endocrinology.2023;[Epub] CrossRef
Case Reports: Transformation of End-Stage Neuroendocrine Tumors With Uncontrollable Liver Metastasis Into a Novel or Additional Functional Phenotype
Takaomi Kessoku, Noritoshi Kobayashi, Masato Yoneda, Yuki Kasai, Anna Ozaki, Naoki Okubo, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Yusuke Kurita, Yasushi Honda, Motohiko Tokuhisa, Hiroto Ishiki, Takashi Hibiya, Satoshi Fujii, Atsushi Nakajim
Frontiers in Oncology.2020;[Epub] CrossRef
Transformation of a non-secretory neuroendocrine tumor to insulinoma after treatment with Sunitinib: A case report and review of the literature
Todd Clover, Amrou Abdelkader, Guru Subramanian Guru Murthy
Journal of Oncology Pharmacy Practice.2019; 25(6): 1516. CrossRef
Hyperglycaemia Induced by Novel Anticancer Agents: An Undesirable Complication or a Potential Therapeutic Opportunity?
Rashmi R. Shah
Drug Safety.2017; 40(3): 211. CrossRef
Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours
Georgios K Dimitriadis, Martin O Weickert, Harpal S Randeva, Gregory Kaltsas, Ashley Grossman
Endocrine-Related Cancer.2016; 23(9): R423. CrossRef
Different Hormonal Expression Patterns Between Primary Pancreatic Neuroendocrine Tumors and Metastatic Sites
Hideyo Kimura, Takao Ohtsuka, Takaaki Fujimoto, Kenjiro Date, Taketo Matsunaga, Ana Ines Cases, Atsushi Abe, Yusuke Mizuuchi, Yoshihiro Miyasaka, Tetsuhide Ito, Yoshinao Oda, Masafumi Nakamura, Masao Tanaka
Pancreas.2016; 45(7): 947. CrossRef
Tyrosine Kinase Inhibitors and Diabetes: A Novel Treatment Paradigm?
Athanasios Fountas, Leonidas-Nikolaos Diamantopoulos, Agathocles Tsatsoulis
Trends in Endocrinology & Metabolism.2015; 26(11): 643. CrossRef
Transformation of nonfunctioning pancreatic tumor into malignant insulinoma after 3 years: an uncommon clinical course of insulinoma
Muyesser Sayki Arslan, Mustafa Ozbek, Melia Karakose, Esra Tutal, Bekir Ucan, Demet Yilmazer, Alper Dilli, Salih Sinan Gultekin, Erman Cakal, Tuncay Delibasi
Archives of Endocrinology and Metabolism.2015; 59(3): 270. CrossRef
Pancreatic neuroendocrine tumors with transformation to insulinoma: an unusual presentation of a rare disease
Avital Nahmias, Simona Grozinsky-Glasberg, Asher Salmon, David J Gross
Endocrinology, Diabetes & Metabolism Case Reports.2015;[Epub] CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

A Case of Familial Multiple Endocrine Neoplasia Type 1 with a Novel Mutation in the MEN1 Gene.: Min Jung Kim, Eun Hee Kim, Mi Seon Shin, Joo Hui Kim, Hee Kyung Na, Seong Joon Park, Sang Ah Lee, Eun Hee Koh, Woo Je Lee, Ki Ho Song, Joong Yeol Park, Ki Up Lee, Gu Hwan Kim, Han Wook Yoo, Min Seon Kim; Endocrinol Metab. 2011;26(2):171-176. Published online June 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.2.171

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Abstract PDF

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterized by the occurrence of multiple tumors in the parathyroid gland, pancreatic islet, and pituitary gland. This condition is caused by mutations of MEN1, a tumor suppressor gene. Thus far, 565 different germline and somatic mutations of the MEN1 gene have been reported. Herein, we describe the case of a 23-year-old woman who suffered from a repetitive loss of consciousness. After workup, the patient was diagnosed with MEN1 with insulinoma, hyperparathyrodism due to parathyroid adenoma, and non-functioning pituitary microadenoma. She underwent a partial parathyroidectomy and distal pancreatectomy. Familial screening of MEN1 revealed that her brother had prolactinoma, hyperparathyroidism, pancreatic gastrinoma and non-functioning adrenal adenoma. Her father had hyperparathyroidism, pancreatic tumor, and adrenal adenoma. Upon genetic analysis of the MEN1 gene, a novel mutation in the MEN1 gene (exon 1, c.251del; p.Ser84LuefsX35) was detected in the patient, as well as her father and brother.

Citations

Citations to this article as recorded by

Parathyroid disorder and concomitant thyroid cancer in patients with multiple endocrine neoplasia type 1
Ying Wang, Sheng Cai, He Liu, Rui-Na Zhao, Xing-Jian Lai, Ke Lv, Yu-Xin Jiang, Jian-Chu Li
Medicine.2021; 100(36): e27098. CrossRef
Genetic and Epigenetic Analysis in Korean Patients with Multiple Endocrine Neoplasia Type 1
Yoon Jung Chung, Sena Hwang, Jong Ju Jeong, Sun Yong Song, Se Hoon Kim, Yumie Rhee
Endocrinology and Metabolism.2014; 29(3): 270. CrossRef

Cystic Insulinoma of the Pancreas.: Sun Wook Cho, Eun Jung Lee, Soo Heon Kwak, Young Min Cho, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee; J Korean Endocr Soc. 2006;21(6):552-555. Published online December 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.6.552

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Abstract PDF: Cystic islet cell neoplasms are among the rarest entities in the differential diagnosis of cystic tumor of the pancreas, and this malady raises difficult clinical problems. The diagnosis of insulinoma could be difficult if the functional activity is incomplete, which possibly leads to blunted symptoms of hypoglycemia and failure in the laboratory to provide evidence of hyperinsulinemia. Furthermore, if the imaging shows a smaller tumor than usual or an unusual morphology like cyctic tumor, then physicians can become somewhat confused. We report here on a clinical case of cystic insulinoma with the typical neuroglycopenic symptoms and laboratory-confirmed hyperinsulinemia. At resection, a 2-cm cavitary mass without central necrosis was excised and this was confirmed histologically as a purely cystic insulioma. This is the first report of a functional cystic insulinoma of the pancreas in Korea. We suggest that the differential diagnosis of endocrine tumor must be considered for any pancreatic cyst, and especially when it is discovered in a patient who is clinically suggestive of having the associated syndrome.

A Case of Malignant Insulinoma Metastasized to Liver after Partial Pancreatectomy due to Insulinoma 10 Years before.: Yang Il Kang, Byung Hyuk Yang, Suk Chon, Seungjoon Oh, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Ju Hie Lee, Kwanpyo Koh; J Korean Endocr Soc. 2006;21(1):68-73. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.68

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Abstract PDF: Malignant insulinomas are very rare endocrine tumours with a variable clinical course. Here, a case of a malignant insulinoma, resected from the tail of the pancreas 10 years previously, which was found to have hepatic metastasis, is reported. A pancreatic mass, without evidence of metastasis, has been found using an abdominal CT scan and intra-operative ultrasonography 10 years previously. Recently, the patient has suffered from dizziness, sweating and an altered mentality. Hyperinsulinemia was diagnosed from the biochemical laboratory finding. An abdominal CT scan and intra-operative abdominal sonography showed multiple hepatic metastasis, without local recurrence in pancreas. Therefore, a partial hepatic segmentectomy was performed. Immunohistochemical staining of the postoperative specimen was strongly positive for insulin. The postoperative biochemical response was normalized, and the patient experienced no further hypoglycemic symptom.

A Case of Multiple Endocrine Neoplasia Type 1 with Mutation in MENIN Gene.: Se Eun Park, Eun Seok Kang, Hyun Joo Lee, So Hun Kim, Mi Young Do, Shin Ae Kang, Seung Jin Han, Hyeong Jin Kim, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Il Jin Kim, Hyun Chul Lee; J Korean Endocr Soc. 2005;20(1):71-77. Published online February 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.1.71

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Abstract PDF

Multiple endocrine neoplasia type 1(MEN 1) is an autosomal dominantly inherited syndrome, characterized by the combined occurrence of tumors of the parathyroid glands, endocrine pancreas, and anterior pituitary gland. The MENIN gene, which is a kind of tumor suppressor gene, is located at the chromosomal locus 11q13. It consists of one untranslated exon and nine exons encoding the menin protein. We report a case of a 22-yearss-old woman with MEN type 1, who was proven to have a mutation in the MENIN gene. The patient was admitted because of repeated hypoglycemia. The fasting plasma glucose level was 32mg/dL. Seventy two hours fasting test showed an the insulin/glucose ratio as 0.33. Endoscopic ultrasonography detected multiple masses on the pancreas. The arterial -stimulated venous sampling(ASVS) with calcium showed sudden step up of insulin at the head and tail portions of the pancreas. The sellar MRI showed a pituitary mass that produced prolactin. Instead of a pathologic diagnosis from operational specimen, the genetic analysis revealed a mutation in the MENIN 1 gene(exon 2, 200~201insAGCCC).

Citations

Citations to this article as recorded by

Genetic and Epigenetic Analysis in Korean Patients with Multiple Endocrine Neoplasia Type 1
Yoon Jung Chung, Sena Hwang, Jong Ju Jeong, Sun Yong Song, Se Hoon Kim, Yumie Rhee
Endocrinology and Metabolism.2014; 29(3): 270. CrossRef
A Case of Familial Multiple Endocrine Neoplasia Type 1 with a Novel Mutation in theMEN1Gene
Min Jung Kim, Eun Hee Kim, Mi-Seon Shin, Joo Hui Kim, Hee Kyung Na, Seong Joon Park, Sang Ah Lee, Eun Hee Koh, Woo Je Lee, Ki Ho Song, Joong-Yeol Park, Ki-Up Lee, Gu-Hwan Kim, Han-Wook Yoo, Min-Seon Kim
Endocrinology and Metabolism.2011; 26(2): 171. CrossRef
Somatic Mutational Analysis of MEN1 and Phenotypic Correlation in Sporadic Parathyroid Tumors
Young Su Chae, Hee Jin Kim, Sun Wook Kim, Myung-Chul Chang
Journal of the Korean Surgical Society.2009; 76(1): 15. CrossRef
Multiple Endocrine Neoplasia Type 1 with Multiple Leiomyomas Linked to a Novel Mutation in the MEN1 Gene
Heekyoung Choi, Sehyun Kim, Jae-Hoon Moon, Yoon Hee Lee, Yumie Rhee, Eun Seok Kang, Chul Woo Ahn, Bong Soo Cha, Eun Jig Lee, Kyung Rae Kim, Hyun Chul Lee, Seon Yong Jeong, Hyun Ju Kim, Sung-Kil Lim
Yonsei Medical Journal.2008; 49(4): 655. CrossRef
A Case of Familial Multiple Endocrine Neoplasia Type 1 with MEN1 Gene Mutation
Young Eun Jo, Yong-Jun Choi, Yun Kyung Kim, Sang Mi Ahn, Sun Hye Jung, Hae Jin Kim, Dae Jung Kim, Kwan Woo Lee, Ji-Hee Hong, Seon-Yong Jeong, Hyon J Kim, Yoon-Sok Chung
Journal of Korean Endocrine Society.2007; 22(1): 68. CrossRef
A Case of Familial Multiple Endocrine Neoplasia with MEN1 Gene Mutation
Hye-Young Sung, Yeon-Joo Chun, Hyeug Lee, Bum Jun Kwon, Kun Woo Park, Jung Min Lee, Sung Dae Moon, Sang Ah Chang, Je-Ho Han
Journal of Korean Endocrine Society.2006; 21(6): 560. CrossRef

A Case of Insulinoma Combined with Pheochromocytoma.: Si Hoon Lee, Young Hoon Youn, Sung Kil Lim, Bong Soo Cha, Hyun Chul Lee, Tae Woong Noh, Kap Bum Huh; J Korean Endocr Soc. 2000;15(4-5):640-647. Published online January 1, 2001

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Abstract PDF: Multiple endocrine neoplasia (MEN) is a combination of endocrine tumor associations and consists of 3 types: 1, 2A and 2B. Herein, we report a case of insulinoma which is combined with pheochromocytoma discovered at the left adrenal gland which was treated by surgical resection. We think there is a possibility of a new type of multiple endocrine neoplasia (MEN).

A Case of Multiple Endocrine Neoplasia Type I Presented with Secondary Amenorrhea and Osteoporosis.: Sang Bum Hong, Seok Jun Hong, Young Ki Song, Ki Soo Kim, Sang Wook Kim, Ki Ub Lee, Min Kyu Kim, Seung Mo Hong, Duck Jong Han; J Korean Endocr Soc. 1998;13(4):684-689. Published online January 1, 2001

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Abstract PDF: MEN type 1 is characterized primarily by the presence of functioning and nonfunctioning tumors or hyperplasia of the pituitary gland, parathyroid glands, and pancreatic islet cells. Pancreatic islet tumors in MEN type 1 produce different kinds of hormone which were pancreatic polypeptide, gastrin, glucagon, insulin and so on. To date, ten cases had been reported in Korea. We report another case with MEN type 1 having prolatin-secreating pituitary adenoma, parathyroid hyperplasia and insulinoma. A 36-year-old woman was admitted because of long-standing amenorrhea and recently diagnosed osteoporosis. Otherwise, she had been in good health except experiencing one episode of loss of consciousness after skipped meal. The blood chemistries were normal except hypercalcemia and hypophosphatemia. Hormonal studies revealed elevated levels of intact PTH and prolactin and decreased value of estradiol with low LH and FSH. The neck CT revealed 1 cm-sized nodule at posterior portion of right thyroid gland and 99mTc-sestamibi sintigraphy showed a increased uptake in left lower and right lower parathyroid glands. The sella MRI showed 0.7 cm-sized enhanced lesion in the left pituitary gland. The ratio of immunoreactive insulin to glucose was elevated and 3-4 pancreatic masses of variable size were identified by endoscopic ultrasonography and angiography. Subtotal parathyroidectomy and pyrolus-preserving pancreaticoduodenectomy with spleen-preserving distal pancreatectomy was done. Postoperative she had been doing well with normocalcemia and normoglycemia. Transsphenoidal adenonectomy was done 5 months later. Histologic examination of removed tissues revealed a single insulinoma, prathyroid hyperplasia and prolactin-secreating pituitary adenoma.

A Case of Somatostatinoma which Manifested as Insulinoma when Metastasized to the Liver.: Joong Yeol Park, Byung Doo Lee, Kyung Soo Ko, Kyung Yub Gong, Ki Soo Kim, Sung Jo Bang, Jae Hwan Lee, Yoon Ey Chung, Sang Wook Kim, Hye Je Cho, Ki Ub Lee; J Korean Endocr Soc. 1998;13(4):670-676. Published online January 1, 2001

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Abstract PDF: We report a case of somatostatinoma, which manifested as insulinoma after liver metastasis. A 74-year-old man suffered from diabetes mellitus and jaundice. The abdominal CT scan of this patient showed a mass in the pancreas head, which obstructed biliary duct. He underwent Whipples procedure. Immunohistochemical staining of postoperative specimen disclosed that this tumor was strongly positive for somatostatin. After 4 months, follow up CT scan showed multiple metastatic lesions in the liver. We performed transarterial chemoinfusion two times, but the response was disappointing. After 2 months, he suffered from altered mentality, which was relieved by intake of sugar. Biochemical laboratory findings and immunohistochemical staining of liver biopsy disclosed that the metastatic lesion in this patient was insulinoma. We performed embolization of hepatic artery with gelform. The biochemical response was dramatic, but he died of septic shock, which was caused by gas forming liver abscess. In summary, we report a case of somatostatinoma which manifested as insulinoma after metastasis to the liver.

A Case of Insulinoma which was treated by Laparoscopic Enucleation.: Ie Byung Park, Young Jae Oh, Jung Heon Oh, Nan Hee Kim, Sang Jin Kim, Se Hyun Baek, Seob Sub Choi, Sung Ok Seo, Min Kyung Kim; J Korean Endocr Soc. 1998;13(4):665-669. Published online January 1, 2001

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Abstract PDF: Insulinoma is a functional endocrine tumor arising from the beta cells of islets of Langerhans of pancreas. The only effective treatment of insulinoma was surgical removal of the tumor. Recently, laparoscopic surgery for islet cell tumors of the pancreas is introduced. Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery We report a case of insulinoma that was treated sucessfully by laparoscopic enucleation.

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