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Spontanhypoglykämien

Insulinome und Differenzialdiagnosen

Spontaneous hypoglycemia

Insulinomas and differential diagnoses

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Spontanhypoglykämien treten unvermutet auf. Häufigste Ursache sind insulinproduzierende Tumoren des endokrinen Pankreas. Bei Verdacht auf ein Insulinom sollte ein Hungerversuch über mindestens 48 h mit dem Ziel des biochemischen Nachweises einer Hypoglykämieneigung bei gleichzeitig inadäquat erhöhten Parametern der (Pro-)Insulinsekretion durchgeführt werden. Besonders treffsicher ist das „verbesserte“ („amended“) Insulin-Glukose-Verhältnis bei Abbruch des Hungerversuchs. Gutartige Insulinome (90%) werden durch Operation geheilt. Bösartige, metastasierende Insulinome sollten ebenfalls mit dem Ziel der Tumorentfernung bzw. -verkleinerung operiert werden. Zusätzlich können Chemotherapie (u. a. mit Streptozotocin), (Chemo-)Embolisierung von Lebermetastasen und antisekretorische Medikamente (Somatostatinanaloga, Diazoxid) eingesetzt werden. Differenzialdiagnostisch sind bei nachgewiesener Hypoglykämie postprandiale, reaktive Hypoglykämien, z. B. nach Magenoperationen, eine Hypoglycaemia factitia (durch Selbstverabreichung von Insulin, Sulfonylharnstoffen oder Meglitiniden), Falschmessungen der Glukose (Gerätefehler, falsche präanalytische Probenbehandlung usw.) und bei alleinigen Symptomen kardiovaskulär und neurologisch-psychiatrisch bedingte Bewusstseinsstörungen abzugrenzen.

Abstract

Spontaneous hypoglycemic episodes occur unexpectedly and the main cause is insulin-producing tumors of the endocrine pancreas. If an insulinoma is suspected a supervised prolonged fast over at least 48 h should be performed to biochemically prove a tendency towards hypoglycemia and inappropriately elevated (pro-)insulin secretory parameters. A high diagnostic accuracy can be achieved using the amended insulin/glucose ratio at the time of discontinuation of prolonged fasts. Benign insulinomas (90 %) can be cured by surgical removal. Malignant (metastasizing) insulinomas should also be treated surgically with the aim of removing or at least debulking the tumor. In addition, chemotherapy (e.g. using streptozotocin), (chemo)embolization of hepatic metastases and anti-secretory medications (somatostatin analogues, diazoxide) can be used. Differential diagnoses, in the case of proven hypoglycemia, include postprandial reactive hypoglycemia, especially after gastric surgery, factitious hypoglycemia (self-medication with insulin, sulfonylureas or meglitinides), and erroneously determined low glucose concentrations (device defect, wrong preanalytic handling). If the suspicion is based on symptoms only, cardiovascular and neurological/psychiatric reasons for a loss of consciousness need to be considered.

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  1. Diabeteszentrum Bad Lauterberg, Kirchberg 21, 37431, Bad Lauterberg im Harz, Deutschland

    M.A. Nauck

  2. Abteilung Diabetologie und Gastrointestinale Endokrinologie, Medizinische Klinik I, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44891, Bochum, Deutschland

    J.J. Meier

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Nauck, M., Meier, J. Spontanhypoglykämien. Diabetologe 9, 47–54 (2013). https://doi.org/10.1007/s11428-012-0914-1

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