Insulinomas

Definición y Epidemiología

Definición

Los LOS Neisseria insulinomas Insulinomas An insulinoma is a type of functional neuroendocrine tumor that manifests with hypoglycemia due to autologous secretion of insulin. It more commonly presents as a solitary benign tumor but can sometimes be associated with MEN type 1 (MEN1). Patients present with fasting hypoglycemia, which may manifest as episodes of diaphoresis, palpitations, tremor, and confusion. Insulinomas son tumores neuroendocrinos pancreáticos que derivan de las células beta y secretan insulina.

Epidemiología

• Incidencia: aproximadamente 1–4 casos por cada millón de personas al AL Amyloidosis año
• Sin predisposición por sexo o raza
• Todos los LOS Neisseria grupos de edad (la incidencia máxima suele ser entre los LOS Neisseria 40 y los LOS Neisseria 60 años)
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 5%–10% de los LOS Neisseria casos, los LOS Neisseria insulinomas Insulinomas An insulinoma is a type of functional neuroendocrine tumor that manifests with hypoglycemia due to autologous secretion of insulin. It more commonly presents as a solitary benign tumor but can sometimes be associated with MEN type 1 (MEN1). Patients present with fasting hypoglycemia, which may manifest as episodes of diaphoresis, palpitations, tremor, and confusion. Insulinomas son malignos.
• Hasta un 10% de los LOS Neisseria casos asociados con el síndrome neoplasia endocrina múltiple tipo 1 (asociado con tumores paratiroideos, pituitarios y pancreáticos)

Fisiopatología

Fisiología normal de la insulina

Síntesis:

• Proinsulina:
  • Almacenada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum gránulos secretores
  • Compuesto por tres cadenas peptídicas: A, B y C
  • Escindida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el aparato de Golgi → insulina y péptido C
• Insulina:
  • Consta de 2 cadenas conectadas por 2 enlaces disulfuro: cadenas A y B
  • Liberada a partir de las células beta del páncreas

Regulación:

• Estimulada por:
  • Composición de los LOS Neisseria alimentos:
    • Glucosa
    • Aminoácidos
    • Ácidos grasos libres
  • Hormonas entéricas:
    • Péptido 1 similar al AL Amyloidosis glucagón ( GLP-1 GLP-1 A peptide of 36 or 37 amino acids that is derived from proglucagon and mainly produced by the intestinal l cells. Glp-1(1-37 or 1-36) is further n-terminally truncated resulting in glp-1(7-37) or glp-1-(7-36) which can be amidated. These glp-1 peptides are known to enhance glucose-dependent insulin release, suppress glucagon release and gastric emptying, lower blood glucose, and reduce food intake. Insulinomas)
    • Polipéptido inhibidor gástrico ( GIP GIP A gastrointestinal peptide hormone of about 43-amino acids. It is found to be a potent stimulator of insulin secretion and a relatively poor inhibitor of gatsric acid secretion. Gastrointestinal Neural and Hormonal Signaling, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés (también conocido como polipéptido insulinotrópico dependiente de glucosa))
    • Colecistoquinina
  • Agonistas neuronales:
    • Estimulación del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors beta-adrenérgico a través de la noradrenalina
    • Acetilcolina
    • Polipéptido intestinal vasoactivo ( VIP VIP A highly basic, 28 amino acid neuropeptide released from intestinal mucosa. It has a wide range of biological actions affecting the cardiovascular, gastrointestinal, and respiratory systems and is neuroprotective. It binds special receptors. Gastrointestinal Neural and Hormonal Signaling, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
• Inhibido por:
  • Estimulación del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors alfa-adrenérgico a través de la noradrenalina
  • Somatostatina

Liberación:

1. La glucosa entra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células beta.
2. Producción de ATP a partir del metabolismo de la glucosa.
3. Cierre de canales de K sensibles a ATP
4. Despolarización de las células beta
5. Afluencia de calcio ( Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)) debido a la apertura de los LOS Neisseria canales de calcio dependiente de voltaje
6. Exocitosis de insulina y péptido C

Función:

• ↑ Captación de glucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el músculo esquelético y tejido adiposo a través del transportador de glucosa tipo 4 (un transportador insulinodependiente)
• ↑ Síntesis de glucógeno
• ↑ Síntesis de proteínas y ↓ proteólisis
• ↑ Síntesis de triglicéridos y ↓ lipólisis
• ↓ Gluconeogénesis y glucogenólisis
• ↓ Liberación de glucagón

Fisiopatología de los LOS Neisseria insulinomas Insulinomas An insulinoma is a type of functional neuroendocrine tumor that manifests with hypoglycemia due to autologous secretion of insulin. It more commonly presents as a solitary benign tumor but can sometimes be associated with MEN type 1 (MEN1). Patients present with fasting hypoglycemia, which may manifest as episodes of diaphoresis, palpitations, tremor, and confusion. Insulinomas

• Los LOS Neisseria insulinomas Insulinomas An insulinoma is a type of functional neuroendocrine tumor that manifests with hypoglycemia due to autologous secretion of insulin. It more commonly presents as a solitary benign tumor but can sometimes be associated with MEN type 1 (MEN1). Patients present with fasting hypoglycemia, which may manifest as episodes of diaphoresis, palpitations, tremor, and confusion. Insulinomas son tumores neuroendocrinos funcionales derivados de las células de los LOS Neisseria islotes pancreáticos.
• Resultan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una secreción de insulina de forma autónoma, incluso cuando la concentración de glucosa plasmática es baja
• Fracaso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la supresión de la insulina más inhibición de síntesis de glucosa → hipoglucemia
• Se produce una estimulación causada por catecolaminas → síntomas
• ↓ Glucosa cerebral → síntomas neuroglucopénicos

Presentación Clínica

Los LOS Neisseria pacientes generalmente presentan hipoglucemia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ayunas, que puede manifestarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum episodios de estimulación simpática y/o alteraciones del sistema nervioso central.

• Síntomas de activación simpática:
  • Temblor
  • Palidez
  • Ansiedad
  • Diaforesis
  • Palpitaciones
• Síntomas neuroglucopénicos:
  • Confusión
  • Visión borrosa
  • Ataxia Ataxia Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharynx, larynx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. Ataxia-telangiectasia
  • Convulsiones
  • Coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma

Diagnóstico

Tríada de Whipple

Una colección de criterios que indican que los LOS Neisseria síntomas de un paciente son el resultado de una hipoglucemia, los LOS Neisseria cuales estarán presentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con un insulinoma Insulinoma A benign tumor of the pancreatic beta cells. Insulinoma secretes excess insulin resulting in hypoglycemia. Pancreatic Neuroendocrine Tumors (PanNETs):

• ↓ Glucosa sérica
• Síntomas de hipoglucemia.
• Resolución de los LOS Neisseria síntomas después de la administración de glucosa.

Estudios de laboratorio

Los LOS Neisseria siguientes valores de laboratorio pueden ayudar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el diagnóstico. Estos estudios se pueden realizar durante una prueba en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ayuno de 48 o 72 horas:

• ↓ Nivel de glucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero
• ↑ Insulina sérica inapropiadamente
• ↑ Péptido C
• ↑ Proinsulina
• Prueba negativa para sulfonilureas

La prueba genética de neoplasia endocrina múltiple tipo 1 se puede realizar para:

• Pacientes jóvenes
• Antecedentes familiares o personales de otras endocrinopatías.

Imagenología

Las siguientes modalidades de imagenología son útiles para localizar el insulinoma Insulinoma A benign tumor of the pancreatic beta cells. Insulinoma secretes excess insulin resulting in hypoglycemia. Pancreatic Neuroendocrine Tumors (PanNETs) y para la planificación preoperatoria:

• TC o RM del abdomen:
  • Pueden detectar entre el 70%–85% de los LOS Neisseria insulinomas Insulinomas An insulinoma is a type of functional neuroendocrine tumor that manifests with hypoglycemia due to autologous secretion of insulin. It more commonly presents as a solitary benign tumor but can sometimes be associated with MEN type 1 (MEN1). Patients present with fasting hypoglycemia, which may manifest as episodes of diaphoresis, palpitations, tremor, and confusion. Insulinomas
  • Hallazgos:
    • Masa sólida pequeña
    • Se realza con contraste
• Imagenología nuclear: se utiliza si en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la imagenología convencional no se encuentran hallazgos relevantes.
• Esofagogastroduodenoscopia con ultrasonido endoscópico del páncreas:
  • Invasiva
  • Puede utilizarse si la TC y la RM son negativas, pero persiste una fuerte sospecha.

Tratamiento

Resección quirúrgica

La extirpación del insulinoma Insulinoma A benign tumor of the pancreatic beta cells. Insulinoma secretes excess insulin resulting in hypoglycemia. Pancreatic Neuroendocrine Tumors (PanNETs) es el tratamiento de elección y proporciona una tasa de curación favorable.

Para tumores resecables (dependiendo del sitio y número del tumor Tumor Inflammation)

• Tienen el pronóstico más favorable.
• Enucleación de tumores solitarios
• Pancreatectomía distal parcial
• Pancreatectomía total
• Procedimiento de Whipple

Para enfermedad metastásica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hígado:

• Resección
• Crioterapia
• Ablación por radiofrecuencia
• Embolización

Terapia médica

Se pueden usar medicamentos para prevenir la hipoglucemia sintomática si el insulinoma Insulinoma A benign tumor of the pancreatic beta cells. Insulinoma secretes excess insulin resulting in hypoglycemia. Pancreatic Neuroendocrine Tumors (PanNETs) es irresecable o el paciente no es un buen candidato para la cirugía.

• Diazóxido:
  • Activador del canal de potasio
  • Inhibe la secreción de insulina.
• Octreótido:
  • Análogo de somatostatina
  • Tratamiento de segunda línea después del diazóxido
  • Puede inhibir la secreción de:
    • Insulina
    • Glucagón
    • Gastrina

Diagnóstico Diferencial

• Hipoglucemia facticia: puede resultar de la autoadministración exógena de insulina. La hipoglucemia facticia se observa a menudo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria trabajadores de la salud que presentan síntomas de hipoglucemia. A diferencia de los LOS Neisseria insulinomas Insulinomas An insulinoma is a type of functional neuroendocrine tumor that manifests with hypoglycemia due to autologous secretion of insulin. It more commonly presents as a solitary benign tumor but can sometimes be associated with MEN type 1 (MEN1). Patients present with fasting hypoglycemia, which may manifest as episodes of diaphoresis, palpitations, tremor, and confusion. Insulinomas, una evaluación de laboratorio revelará niveles bajos de péptido C y proinsulina a pesar de los LOS Neisseria niveles altos de insulina. El tratamiento incluye la corrección de la hipoglucemia y terapia psiquiátrica.
• Toxicidad por sulfonilureas: puede ocurrir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes que no tienen una correcta alimentación o tienen insuficiencia renal. Los LOS Neisseria pacientes presentarán hipoglucemia. A diferencia de los LOS Neisseria insulinomas Insulinomas An insulinoma is a type of functional neuroendocrine tumor that manifests with hypoglycemia due to autologous secretion of insulin. It more commonly presents as a solitary benign tumor but can sometimes be associated with MEN type 1 (MEN1). Patients present with fasting hypoglycemia, which may manifest as episodes of diaphoresis, palpitations, tremor, and confusion. Insulinomas, la prueba de sulfonilurea sérica será positiva. El tratamiento incluye la suspensión del agente causal y el tratamiento de la hipoglucemia.
• Hipoglucemia hiperinsulinémica persistente de la infancia: la causa más común de hipoglucemia persistente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum recién nacidos y lactantes, es causada por mutaciones que involucran diferentes proteínas que conducen a una desregulación de la liberación de insulina. Los LOS Neisseria exámenes de laboratorio mostrarán niveles indebidamente detectables de insulina y péptido C, niveles bajos de beta-hidroxibutirato y ácidos grasos libres y una respuesta glucémica al AL Amyloidosis glucagón. A menudo se realizan pruebas genéticas. El tratamiento puede incluir diazóxido, octreótido o cirugía.
• Síndrome de hipoglucemia autoinmune: ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes que tienen autoanticuerpos dirigidos a la insulina endógena o al AL Amyloidosis receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de insulina, lo que da lugar a hipoglucemia. La detección de anticuerpos a la insulina proporcionará el diagnóstico. Esta afección se trata con comidas pequeñas y frecuentes; esteroides y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos graves, plasmaféresis.