İnsülinoma Tanı ve Tedavi Yaklaşımları
Özet
İnsülinoma, fonksiyonel pankreas nöroendokrin tümörleri arasında en sık görülen, kontrolsüz insülin salgılanması ve buna bağlı gelişen hipoglisemi semptomları ile karakterize nadir bir hastalıktır. Genellikle sporadik, soliter ve 2 cm'den küçük benign kitleler olarak ortaya çıksa da, vakaların küçük bir kısmı malign özellik gösterebilir veya MEN 1 sendromu ile ilişkili olabilir. Tanı sürecinde, açlık sırasında tetiklenen hipoglisemi ataklarını, kan glukoz düzeyinin düşüklüğünü ve glukoz alımıyla semptomların düzelmesini içeren "Whipple Triadı" temel alınır; tanı 72 saatlik açlık testi ve biyokimyasal ölçümlerle kesinleştirilir. Tümörün yerini belirlemek amacıyla ultrasonografi, bilgisayarlı tomografik anjiyografi, manyetik rezonans görüntüleme ve endosonografi gibi preoperatif non-invaziv ve invaziv yöntemlerin yanı sıra intraoperatif ultrasonografiden yararlanılır. Kür şansı %95'in üzerinde olan cerrahi müdahale (enükleasyon veya parsiyel pankreas rezeksiyonu) birincil tedavi seçeneğidir. Cerrahiye uygun olmayan veya malignitesi bulunan hastalarda ise beslenme alışkanlıklarının düzenlenmesi, diazoksid ve oktreotid gibi farmasötik ajanları içeren medikal tedaviler ile transkateter arteryal embolizasyon veya radyofrekans ablasyon gibi ablatif yöntemler tercih edilerek semptom kontrolü sağlanmaya çalışılır.
Insulinoma is the most common functional pancreatic neuroendocrine tumor, characterized by uncontrolled insulin secretion and subsequent hypoglycemic symptoms. Although usually presenting as sporadic, solitary, and benign masses smaller than 2 cm, a small fraction of cases exhibit malignant behavior or occur as part of the MEN 1 syndrome. Diagnosis is fundamentally based on the "Whipple Triad"—comprising fasting-induced hypoglycemic symptoms, low blood glucose, and symptom resolution upon glucose administration—and is confirmed through a 72-hour fasting test alongside biochemical evaluations. To determine the exact tumor location, preoperative non-invasive and invasive imaging modalities such as ultrasonography, computed tomography, magnetic resonance imaging, and endosonography are utilized, supplemented by intraoperative ultrasonography. Surgical intervention (enucleation or partial pancreatic resection) remains the primary definitive treatment, offering a cure rate exceeding 95%. For inoperable or malignant cases, medical management including dietary adjustments and pharmaceutical agents like diazoxide or octreotide, alongside ablative methods such as transcatheter arterial embolization or radiofrequency ablation, is implemented to effectively control clinical symptoms.
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