Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection
It has been proposed that rebound hyperglycemia after resection of insulinoma indicates a biochemical cure. However, there is scant objective data in the literature on the rate and need for intervention in hyperglycemia in patients undergoing resection of insulinoma. The goal of our study was to evaluate the rate of postoperative hyperglycemia, any predisposing factors, and the need for intervention in a prospective cohort study of all patients undergoing routine glucose monitoring.
A retrospective analysis of 33 patients who had an insulinoma resected and who underwent routine postoperative monitoring of blood glucose (every hour for the first six hours then every four hours for the first 24 h) was performed. Hyperglycemia was defined as glucose greater than 180 mg/dL (10 mmol/l).
Twelve patients (36%) developed hyperglycemia within 24 h (range 1–16 h). In patients with hyperglycemia, the mean maximum plasma glucose level was 221.5 mg/dL (range 97–325 mg/dL) (12.3 mmol/l), and four (33%) patients were treated with insulin. There was no significant difference in age, gender, body mass index (BMI), tumor size, biochemical profile, or surgical approach and extent of pancreatectomy between patients who developed hyperglycemia and those who did not. Pre-excision and post-excision intraoperative insulin levels were evaluated in 14 of 33 patients. The percentage decrease of the intraoperative insulin levels was not significantly different between patients who developed hyperglycemia and those who did not. All patients with postoperative hyperglycemia had normalization of their glucose levels, and none were discharged on anti-hyperglycemic agents.
Hyperglycemia is common after insulinoma resection, and a subset of patients require transient treatment with insulin.
KeywordsInsulinoma Pancreatic neuroendocrine tumor Hyperglycemia Surgery
Intramural Research Program, National Cancer Institute, National Institutes of Health.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.J.M. Guettier, A. Lungu, A. Goodling, C. Cochran, P. Gorden, The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 98, 4752–4758 (2013). https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-2182CrossRefPubMedPubMedCentralGoogle Scholar
- 9.S.S. Schwartz, D.L. Horwitz, B. Zehfus, B.G. Langer, E. Kaplan, Continuous monitoring and control of plasma glucose during operation for removal of insulinomas. Surg. 85, 702–707 (1979). http://www.ncbi.nlm.nih.gov/pubmed/222000Google Scholar
- 10.H.Y. Chang, H.S. Huang, J.D. Lin, B.Y. Huang, M.J. Huang, L.B. Jeng, Insulinoma--clinical experience in ten cases. Chang. yi xue za zhi 17, 28–38 (1994). http://www.ncbi.nlm.nih.gov/pubmed/8205495Google Scholar
- 15.J. Puig la Calle, P. Clavé, G. Capella, C. Fidal, J.M. Pou, F. Lluis, Rebound hyperglycemia and peroperative normalization of insulinemia. Complet. excision Insul? Chirurgie 118, 284-8-91 (1992)Google Scholar
- 19.P. Nockel, B. Babic, C. Millo et al. Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan. J. Clin. Endocrinol. Metab. 102, 2016–3445 (2016). http://www.ncbi.nlm.nih.gov/pubmed/27805844Google Scholar
- 20.NICE-SUGAR Study Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, S. Finfer, D. Chittock et al. Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study. Intensive Care Med. 41, 1037–1047 (2015). http://www.ncbi.nlm.nih.gov/pubmed/26088909CrossRefGoogle Scholar