Laparoscopic Distal Pancreatectomy for a Glucose-responsive Insulinoma

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  • 糖反応性低血糖を呈するインスリノーマに対して術中糖負荷試験を併用し腹腔鏡下膵尾部切除術を施行した1例

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<p>A 57-year-old woman presented hypoglycemia during or after a meal. The laboratory findings, including endocrine hormone levels were within the normal range, but the 75 g-oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (ivGTT) indicated excessive insulin secretion and hypoglycemia. A starvation test showed no excessive insulin secretion. Dynamic CT showed a solitary tumor in the pancreatic tail, which was diagnosed as a glucose-responsive insulinoma. Angiography and arterial stimulation venous sampling results supported this diagnosis and showed no metastasis. We performed a laparoscopic spleen-preserving distal pancreatectomy. Additionally, we performed intraoperative ivGTT post-resection that indicated normoglycemia and normal insulin secretion, confirming the absence of residual tumor. To the best of our knowledge, this is the first report of an intraoperative GTT. Hence, we report a rare case of glucose-responsive insulinoma and the usefulness of intraoperative GTT.</p>

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