Clinical Features Of Insulinoma And The Incidence Of Glucose Metabolism Disorders During The Follow-up Of Surgically Treated Insulinomas

Object: By analyzing the clinical data and long-term follow-up results of patients with insulinoma,summarize the clinical characteristics of insulinoma,assess the incidence of glucose metabolism disorders during the long-term follow-up of surgically treated insulinomas,and explore whether the preoperative,perioperative and postoperative factors can be used to predict the occurrence of glucose metabolism disorders during the long-term follow-up of surgically treated insulinomas.Methods: Retrospective analysis of the data of 32 patients with insulinoma diagnosed in our hospital from August 2012 to February 2020,including demographic data,clinical manifestations,Laboratory indicators,imaging data,surgical treatment,tumor characteristics,perioperative complications,and long-term follow-up of postoperative glucose metabolism,tumor recurrence and metastasis.Results:(1)Baseline characteristics: The average age of 32 patients was 43.13±16.64 years,the male to female ratio was 1:1.67,and 65.62%(21/32)of the patients had a disease course of ≥ 1 year.The most common clinical symptoms are loss of consciousness(59.3%)and profuse sweating(46.8%).CT(Computed tomography)has the highest positive rate(92.86%)in non-invasive examinations.The average diameter of the tumor was 1.93±1.09 cm.(2)Surgery,pathology and tumor recurrence: 26 patients underwent surgical treatment,14 patients underwent pancreatic tumor resection,and 12 underwent partial pancreatectomy.Pathological results were confirmed to be insulinoma.The pathological stage of insulinoma was G1 accounted for 23.08%,and the pathological stage of G2 accounted for 76.92%.Immunohistochemistry,the positive rate of Cg A,Syn,Insulin is respectively 76.92%,100%,53.85%.Among the 24 surgically treated patients who were successfully followed up,one person found symptomatic liver metastases 3 years after the operation.(3)The incidence of early postoperative hyperglycemia(peripheral blood glucose greater than 10mmol/L within 1 week after surgery)and predictive factors: 38.46% of patients have early postoperative hyperglycemia.The blood glucose levels of these patients return to normal within 2-4 weeks.The age,gender,BMI(Body mass index),synchronous insulin,and synchronous C-peptide level were not statistically related with the occurrence of early postoperative hyperglycemia.(4)The incidence of long-term glucose metabolism disorders(Follow-up time> 1 year,diagnosed as diabetes or pre-diabetes)and predictive factors: 24 surgical patients were successfully followed up,and 2 were lost to follow-up.The median follow-up time was64(42,84)months.During the follow-up process,it was found that most patients did not pay attention to blood glucose.During the follow-up,the incidence of glucose metabolism disorders was 29.17%(4 people with pre-diabetes,3 people with diabetes).One patient developed microvascular disease(Diabetic nephropathy was diagnosed due to edema of both lower extremities at 98 months after surgery),but no large vessel disease was found.Twenty-three patients(1 patient with symptomatic liver metastases were not included in the analysis)were divided into a long-term glucose metabolism disorders group after operation and a long-term normal glucose metabolism group after operation.It was found that patients with early postoperative hyperglycemia had higher incidence of glucose metabolism disorders(85.71%)than that in patients with normal blood glucose in the early postoperative period during the long-term follow-up of surgically treated insulinomas.The difference was statistically significant(p=0.019).The incidence of abnormal glucose metabolism(71.43%)in patients who underwent partial pancreatectomy in the long-term follow-up of surgically treated insulinomas was higher than that in patients who underwent pancreatic mass resection,and the difference between the two groups was statistically significant(p=0.027).Multivariate binary logistic regression analysis indicated that early postoperative hyperglycemia(OR 18.000;CI1.632-198.508;p=0.018)was an independent risk factor for long-term postoperative glucose metabolism disorders.Conclusion:1.The most common clinical symptoms of insulinoma are loss of consciousness and profuse sweating.CT has the highest positive rate in non-invasive examinations.If necessary,a combination of multiple examination methods can increase the detection rate of tumors.2.The incidence of glucose metabolism disorders is increased during the long-term follow-up of surgically treated insulinomas.Early postoperative hyperglycemia is an independent risk factor for glucose metabolism disorders in long-term follow-up.For patients with insulinoma after surgery,especially those with early postoperative hyperglycemia,blood glucose,glycosylated hemoglobin and other related indicators of glucose metabolism should be monitored regularly to achieve early detection,early diagnosis,and early treatment of diabetes,and reduce the occurrence of diabetes complications.