I-Insulinoma wuhlobo oluyivelakancane lwesimila kumanyikwe olukhula ngezindleko zamaseli akhiqiza i-insulin. Ukuba khona kwayo kuyimbangela yokuhlaselwa kwe-hypoglycemia kwesinye isikhathi. Imvamisa i-benig and encane ngosayizi, isimila akulula ngaso sonke isikhathi ukusithola. Izinga lokuphumelela lokususwa ngokuhlinzwa liphezulu.

Incazelo

I-insulinoma iyithumba lama-pancreas, elibizwa nge-endocrine ngoba lidala ukukhiqizwa kwe-insulin ngokweqile. Le hormone ye-hypoglycemic ngokuvamile ikhiqizwa ngendlela elawulwa yikilasi lamaseli ku-pancreas, amaseli e-beta, ukuze ehlise amazinga kashukela egazini lapho ekhuphuka kakhulu. Kepha ukugcinwa kwe-insulin yi-tumor akulawuleki, okuholela eziqephuni zokuthi "ukusebenza" kwe-hypoglycemia kubantu abadala abanempilo, abangenaso isifo sikashukela.

Cishe amaphesenti angama-90 e-insulinomas angama-benign tumors angawodwa. Ingxenye encane ihambelana nezimila eziningi kanye / noma eziyingozi - lezi zamuva zihlukaniswa nokuvela kwama-metastases.

Lezi zimila ngokuvamile zincane: eziyisishiyagalolunye kweziyishumi azidluli u-2 cm, kanti ezintathu kweziyishumi zingaphansi kuka-1 cm.

Izimbangela

Iningi lama-insulinomas avela ngezikhathi ezithile, ngaphandle kwesizathu esihlonziwe. Ezimweni ezingavamile, izici zofuzo zihilelekile.

kwesifo

Ukuba khona kwe-insulinoma kufanele kucatshangelwe lapho umuntu ongelasifo sikashukela eveza izimpawu zeziqephu eziphindaphindayo ze-hypoglycemia ngaphandle kwanoma yisiphi esinye isizathu esisobala (utshwala, izinso, isibindi noma ukungasebenzi kahle kwezindlala ze-adrenal, izidakamizwa, njll.).

I-insulinoma ibonakala ngamazinga aphansi kakhulu kashukela egazini kuhlanganiswe namazinga e-insulin aphezulu ngokungavamile. Ukukhombisa lokhu, senza ukuhlolwa kokuzila ukudla okuthatha amahora angama-72 ngaphansi kokuqondisa kodokotela. Ukuxilongwa kususelwa ekuhlolweni kwegazi okuthathwa lapho kuvela izimpawu ze-hypoglycemia. Ukuhlolwa kuyekwa ngokushesha lapho izinga likashukela egazini lehla kakhulu.

Izivivinyo zokuthwebula zenziwa ukuze kutholwe i-insulinoma. Ukuhlolwa kwereferensi i-echo-endoscopy, evumela ucwaningo olunembile lwamanyikwe kusetshenziswa ishubhu eguquguqukayo efakwe ikhamera kanye ne-miniature ultrasound probe, engeniswe ohlelweni lokugaya ukudla ngomlomo. Okunye ukuhlola okufana ne-angio-scanner nakho kungasiza.

Naphezu kwentuthuko ekuthwebuleni izithombe, ukuthola izimila ezincane kusenzima. Ngezinye izikhathi kwenziwa ngemva kokuhlinzwa kokuhlolwa ngenxa ye-palpation ehlanganiswe ne-intraoperative ultrasound, kusetshenziswa i-ultrasound probe ethile.

Abantu abathintekayo

Nakuba iyimbangela evame kakhulu ye-tumor hypoglycaemia kubantu abadala, i-insulinoma isalokhu iyithumba elingajwayelekile, elithinta umuntu oyedwa kuya kwabangu-1 kwisigidi sezakhamuzi (izigameko ezintsha ezingama-2 kuye kweziyi-50 unyaka ngamunye eFrance).

Ukuxilongwa kuvame ukwenziwa lapho sebeneminyaka yobudala engama-50. Abanye ababhali baqaphela ukugcwala kancane kwabesifazane.

Izici zengozi

Kuyaqabukela, i-insulinoma ihlotshaniswe nohlobo loku-1 lwe-endocrine neoplasia eningi, isifo esingajwayelekile esitholakala ngofuzo esibonakaliswa ukuba khona kwamathumba kuzindlala eziningana ze-endocrine. Ingxenye yesine yalawa ma-insulinoma ayingozi. Ingozi yokuthola i-insulinoma nayo ingahlotshaniswa kancane nezinye izifo zofuzo (isifo sika-von Hippel Lindau, i-Recklinghausen neurofibromatosis kanye ne-Bourneville tuberous sclerosis).

Iziqephu ze-hypoglycemia ejulile zivame ukuvela - kodwa hhayi ngokuhlelekile - ekuseni esiswini esingenalutho noma ngemva kokuzivocavoca.

Umthelela ohlelweni lwezinzwa lokushoda kweglucose 

Izimpawu zihlanganisa ukuzizwa ubuthakathaka futhi ungaphilile kahle noma uqulekile, ikhanda elibuhlungu, ukuphazamiseka kokubona, ukuzwela, amakhono emisipha noma ukusebenzisana kahle, ukulamba kungazelelwe ... Ezinye izimpawu ezinjengokudideka noma ukuphazamiseka ekugxiliseni ingqondo, ubuntu noma ukuziphatha kungase kulingise ukugula kwengqondo noma kwemizwa, okwenza kube nzima ukuxilonga. .

Yidla i-hypoglycemic

Ezimweni ezimbi kakhulu, i-hypoglycemia ibangela ukuqubuka kungazelelwe, kujule kancane futhi kuvame ukuhambisana nokujuluka okukhulu.

Ezinye izimpawu

Lezi zimpawu zivame ukuhlotshaniswa nezimpawu zokusabela okuzenzakalelayo ku-hypoglycemia:

• ukukhathazeka, ukuthuthumela
• isicashunwe,
• umuzwa wokushisa nokujuluka,
• i-pallor,
• tachychardie...

   

Iziqephu eziphindaphindiwe ze-hypoglycemia zingaholela ekwehleni kwesisindo.

Ukususwa kokuhlinzwa kwe-insulinoma kunikeza imiphumela emihle kakhulu (izinga lokwelapha cishe lingama-90%).

Uma isimila sisodwa futhi senziwe sasendaweni kahle, ukungenelela kungase kuhloswe kakhulu (i-enucleation) futhi ukuhlinzwa okuncane kakhulu kwanele ngezinye izikhathi. Uma indawo ingacacile noma uma kwenzeka izimila eziningi, kungenzeka futhi ukwenza ukususwa kwengxenye ye-pancreas (pancreatectomy).

Ukulawula ushukela egazini

Ngenkathi ulinde ukuhlinzwa noma uma izimpawu ziqhubeka ngemva kokuhlinzwa, imithi efana ne-diazoxide noma i-somatostatin analogue ingasiza ekuvimbeleni ushukela wegazi ukuba wehle kakhulu.

Lapho ubhekene ne-insulinoma ebulalayo engasebenzi, eyizimpawu noma eqhubekayo, izindlela zokwelapha ezahlukahlukene zokulwa nomdlavuza zingasetshenziswa:

• Ukwelashwa ngamakhemikhali kufanele kucatshangelwe ukuze kuncishiswe isimila esikhulu.
• I-Everolimus, i-immunosuppressive antitumor agent, ingase ibe usizo uma i-hypoglycemia iphikelela.
• I-Metabolic radiotherapy isebenzisa izinto ezikhipha imisebe elawulwa umzila we-venous noma ngomlomo, obopha ngokukhethekile kumaseli omdlavuza ukuze uwabhubhise. Igcinelwe izimila ezibonisa ama-metastases amathambo ambalwa kanye/noma ezikhula kancane.