Zusammenfassung
Hintergrund: Das Insulinom ist ein seltener, meist gutartiger neuroendokriner Tumor mit einer
Inzidenz von etwa vier Fällen pro einer Millionen Personenjahre. Kasuistiken über
Insulinome während einer Schwangerschaft sind nur vereinzelt beschrieben worden. Fallbeschreibung: Eine 34-jährige Frau (Gravida 1, Para 1) stellte sich mit schweren Hypoglykämien
nach ihrer Entbindung vor. Die endokrinologischen Untersuchungen ergaben ein Insulinom
mit erhöhten Nüchternspiegeln von Insulin, Proinsulin und C-Peptid während einer hypoglykämischen
Episode. Daraufhin wurden regelmäßige Blutzuckermessungen, häufige kohlenhydratreiche
Mahlzeiten und eine kontinuierliche intravenöse Glukoseinfusion veranlasst. Eine Endosonographie,
eine Magnetresonanztomographie sowie ein selektiver arterieller Kalziumstimulationstest
bestätigten eine Raumforderung im Pankreaskorpus. Während einer chirurgischen Exploration
mittels intraoperativem Ultraschall wurde die Pankreasraumforderung reseziert. Die
histologischen Untersuchungen zeigten ein gutartiges Insulinom entsprechend der Klassifikation
der World Health Organization (WHO). Postoperativ sistierten alle hypoglykämischen
Symptome, ohne dass eine weitere Therapie erforderlich wurde. Schlussfolgerung: In der Schwangerschaft kann ein Insulinom unter Umständen maskiert werden durch das
Insulin antagonisierende und somit Insulinresistenz begünstigende Hormone. Insulinome
in der Schwangerschaft sollten, auch wenn sie insgesamt selten sind, in die Differentialdiagnosen
der postpartalen Hypoglykämie eingeschlossen werden.
Abstract
Background: Insulinomas are rare, mostly benign neuroendocrine tumours with an incidence of approximately
four cases per million person-years. Only isolated case reports of insulinomas occurring
in pregnancy have been documented. Case Report: A 34-year-old woman (gravida 1, para 1) presented with severe hypoglycaemia after
delivery. Endocrine testing was consistent with insulinoma showing elevated fasting
insulin, pro-insulin, and C-peptide levels in the setting of hypoglycaemia. The patient
was managed with glucose monitoring, frequent carbohydrate-rich meals, and continuous
intravenous glucose infusions. Endoscopic ultrasonography, magnetic resonance imaging,
and selective arterial calcium stimulation confirmed a mass in the corpus of the pancreas.
During surgical exploration using intraoperative ultrasonography the pancreatic mass
was removed. Histology was consistent with a benign insulinoma according to the World
Health Organization (WHO) classification. Postoperatively, all hypoglycaemic symptoms
resolved with no further treatment. Conclusion: Insulinoma may be masked by pregnancy due to insulin-antagonist hormones inducing
insulin resistance. Insulinoma in pregnancy, though very rare, should be included
in the differential diagnosis of postpartum hypoglycaemia.
Schlüsselwörter
Insulinom - Hypoglykämie - Schwangerschaft - Insulinresistenz
Key words
Insulinoma - hypoglycaemia - pregnancy - insulin resistance
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Dr. med. Karsten Müssig
Medizinische Klinik IV
Universitätsklinikum Tübingen
Otfried-Müller-Strasse 10
D-72076 Tübingen
Phone: +49-(0)7071-29 83 670
Fax: +49-(0)7071-29 27 84
Email: Karsten.Muessig@med.uni-tuebingen.de
