Insulinoma ndi mtundu wosowa wa chotupa cha kapamba chomwe chimakula ndikuwononga ma cell omwe amatulutsa insulin. Kukhalapo kwake ndizomwe zimayambitsa nthawi zina zovuta za hypoglycemia. Nthawi zambiri zabwino ndi zazing'ono kukula, chotupacho si nthawi zonse zosavuta kupeza. Kupambana kwa opaleshoni kuchotsa ndipamwamba.

Tanthauzo

Insulinoma ndi chotupa cha kapamba, chotchedwa endocrine chifukwa chimayambitsa kutulutsa kwa insulini kwambiri. Hormone iyi ya hypoglycemic nthawi zambiri imapangidwa motsogozedwa ndi gulu la maselo a kapamba, maselo a beta, kuti achepetse kuchuluka kwa shuga m'magazi akakwera kwambiri. Koma kutulutsa kwa insulin ndi chotupacho sikumayendetsedwa, zomwe zimapangitsa kuti pakhale zochitika zotchedwa "zogwira ntchito" hypoglycemia mwa akuluakulu athanzi, omwe alibe matenda a shuga.

Pafupifupi 90% ya insulinomas ndi zotupa zapayekha. Gawo laling'ono limafanana ndi zotupa zingapo komanso / kapena zowopsa - zomalizazi zimasiyanitsidwa ndi kupezeka kwa metastases.

Zotupazi nthawi zambiri zimakhala zazing'ono: zisanu ndi zinayi mwa khumi sizidutsa 2 cm, ndipo zitatu mwa khumi ndi zosakwana 1 cm.

Zimayambitsa

Ma insulinoma ambiri amawonekera apo ndi apo, popanda chifukwa chodziwika. Nthawi zambiri, kutengera cholowa kumakhudzidwa.

matenda

Kupezeka kwa insulinoma kuyenera kuganiziridwa ngati munthu wopanda matenda a shuga akuwonetsa zizindikiro za hypoglycemia popanda chifukwa china chodziwikiratu (kuledzera, aimpso, hepatic kapena adrenal insufficiency, mankhwala, etc.).

Insulinoma imawonetsedwa ndi kutsika kwambiri kwa shuga m'magazi kuphatikiza ndi insulin yokwera modabwitsa. Kuti tiwonetse izi, timayesa kusala kudya kwa maola 72 moyang'aniridwa ndi achipatala. Kuzindikira kumatengera kuyezetsa magazi komwe kumatengedwa ngati zizindikiro za hypoglycemia zimachitika. Kuyezetsako kumayimitsidwa pomwe kuchuluka kwa glucose m'magazi kutsika kwambiri.

Mayeso oyerekeza amachitidwa kuti apeze insulinoma. Kufufuzako ndi echo-endoscopy, yomwe imalola kusanthula bwino kapamba pogwiritsa ntchito chubu chosinthika chokhala ndi kamera komanso kachipangizo kakang'ono ka ultrasound, komwe kamalowa m'matumbo kudzera pakamwa. Mayesero ena monga angio-scanner angakhalenso othandiza.

Ngakhale kuti zithunzi zapita patsogolo, kupeza zotupa zazing'ono kumakhalabe kovuta. Nthawi zina zimachitika pambuyo opaleshoni opaleshoni chifukwa palpation pamodzi ndi intraoperative ultrasound, ntchito yeniyeni ultrasound kafukufuku.

Anthu okhudzidwa

Ngakhale kuti insulinoma ndiyomwe imayambitsa kwambiri chotupa cha hypoglycemia mwa akulu akulu, insulinoma imakhalabe chotupa chosowa kwambiri, chomwe chimakhudza anthu 1 mpaka 2 pa miliyoni miliyoni (50 mpaka 100 atsopano chaka chilichonse ku France).

Matendawa nthawi zambiri amapangidwa pafupi ndi zaka za 50. Olemba ena amawona kuti amayi ali ndi vuto laling'ono.

Zowopsa

Nthawi zambiri, insulinoma imalumikizidwa ndi mtundu woyamba wa endocrine neoplasia, matenda osowa cholowa omwe amawonetsedwa ndi kupezeka kwa zotupa m'magulu angapo a endocrine. Gawo limodzi mwa magawo atatu a insulinomas awa ndi owopsa. Chiwopsezo chokhala ndi insulinoma chitha kulumikizidwanso pang'ono ndi matenda ena obadwa nawo (matenda a von Hippel Lindau, Recklinghausen neurofibromatosis ndi Bourneville tuberous sclerosis).

Nthawi zambiri hypoglycemia imawonekera - koma osati mwadongosolo - m'mawa musanadye kapena mukatha kuchita masewera olimbitsa thupi.

Zotsatira pamitsempha yamanjenje yakusowa kwa glucose 

Zizindikiro zake ndi monga kufooka kapena kusachita bwino kapena popanda chikomokere, mutu, kusokonezeka kwa maso, kukhudzidwa, luso lagalimoto kapena kulumikizana, njala yodzidzimutsa ... .

Idyani hypoglycemic

Muzochitika zowopsa kwambiri, hypoglycemia imayambitsa kukomoka mwadzidzidzi, mozama kapena mocheperapo ndipo nthawi zambiri kumatsagana ndi thukuta kwambiri.

Zizindikiro zina

Zizindikiro izi nthawi zambiri zimagwirizanitsidwa ndi zizindikiro za autonomic reaction to hypoglycemia:

• nkhawa, kunjenjemera
• mseru,
• kumva kutentha ndi thukuta,
• mbala,
• tachychardie…

   

Kubwerezabwereza kwa hypoglycemia kumatha kuyambitsa kunenepa.

Kuchotsa opareshoni kwa insulinoma kumapereka zotsatira zabwino kwambiri (kuchiritsa pafupifupi 90%).

Pamene chotupacho chili chokhazikika komanso chodziwika bwino, kulowererapo kungakhale kolunjika kwambiri (enucleation) ndipo opaleshoni yochepa kwambiri nthawi zina imakhala yokwanira. Ngati malowa ndi osadziwika bwino kapena pakachitika zotupa zingapo, ndizothekanso kuchotsa kapamba (pancreatectomy).

Kuwongolera shuga m'magazi

Poyembekezera opaleshoni kapena ngati zizindikiro zikupitirirabe pambuyo pa opaleshoni, mankhwala monga diazoxide kapena somatostatin analogues angathandize kuti shuga asamatsike kwambiri.

Poyang'anizana ndi insulinoma yosagwira ntchito, yowonetsa kapena yopitilira patsogolo, njira zingapo zothana ndi khansa zitha kukhazikitsidwa:

• Chemotherapy iyenera kuganiziridwa kuti ichepetse chotupa chachikulu.
• Everolimus, immunosuppressive antitumor agent, ikhoza kukhala yothandiza ngati hypoglycemia ipitilira.
• Metabolic radiotherapy imagwiritsa ntchito zinthu zotulutsa ma radio zomwe zimayendetsedwa ndi venous kapena pakamwa, zomwe makamaka zimamanga ma cell a khansa kuti awawononge. Amasungira zotupa zomwe zimawonetsa ma metastases ochepa m'mafupa komanso / kapena kukula pang'onopang'ono.