Symptommaskierung eines Insulinoms durch Schwangerschaft

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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