ʻO Insulinoma

ʻO ka insulinoma kahi tumo i ka pancreas e hana ana i ka nui o ka insulin.

ʻO ka pancreas kahi lālā i loko o ka ʻōpū. Hana ka pancreas i kekahi mau enzymes a me nā hormones, me ka hormone insulin. ʻO ka hana a Insulin e hoʻoliʻiliʻi i ke kiʻekiʻe o ke kō (glucose) i ke koko ma ke kōkua ʻana i ke kō e neʻe i loko o nā hunaola.

ʻO ka hapa nui o ka manawa ke emi iho kou kiʻekiʻe kō kō, kū i ka pancreas ka hana ʻana i ka insulin e hōʻoia i ka paʻa o kāu kō kō i ka pae maʻamau. ʻO nā tumors o ka pancreas e hana i ka nui o ka insulin i kapa ʻia ʻo insulinomas. Mālama mau ʻo Insulinomas i ka hana ʻana i ka insulin, a hiki ke hoʻohaʻahaʻa loa i kou kō kō kō (hypoglycemia).

ʻO ke kiʻekiʻe o ka insulin koko kiʻekiʻe ke kumu o kahi pae kō kō haʻahaʻa (hypoglycemia). Akahai paha ka Hypoglycemia, hiki i nā ʻōuli e like me ka hopohopo a me ka pōloli. A i ʻole hiki ke paʻakikī, alakaʻi i ka hopu ʻana i ka maʻi, koma, a me ka make pū kekahi.

ʻO nā tumole he mea laha ʻole. Kū pinepine lākou ma ke ʻano he hoʻokahi, ʻemi liʻiliʻi. Akā hiki nō i kekahi mau tumors liʻiliʻi.

ʻO ka hapanui o nā insulinomas he tumant non-cancerous (benign). ʻO ka poʻe me kekahi mau maʻi genetical, e like me nā endocrine neoplasia type I, ʻoi aku ka nui o ka makaʻu no ka insulinomas.

Kūleʻa pinepine nā ʻōuli i ka wā e hoʻokē ʻai a lele hoʻi a hoʻolohi paha i kahi pāʻina. Pākuʻi ʻia paha nā ʻōuli:

• Ka pīhoihoi, nā loli a me nā huikau paha
• ʻIʻike kapua
• Ka nalowale o ka ʻike a i ʻole ke koma
• Hoʻohuli a haʻalulu paha
• Pōpō a poʻo ʻeha paha
• Pōloli i waena o nā meaʻai; maʻa mau ke kaupaona
• ʻO ka wikiwiki o ka puʻuwai a i ʻole palpitations
• Hoʻoulu

Ma hope o ka hoʻokē ʻai ʻana, e hoʻāʻo ʻia kou koko no:

• Kaha C-peptide pae
• Pae kō glucose
• Pae pae insulin
• Nā lāʻau i kumu e hoʻokuʻu ka pancreas i ka insulin
• ʻO ka pane o kou kino i kahi kī o glagagon
  

Hana ʻia ʻo CT, MRI, a i ʻole PET scan o ka ʻōpū e nānā no kahi tumo i ka pancreas. Inā ʻaʻole ʻike ʻia kahi tumo i ka scans, hana ʻia kekahi o nā hōʻike aʻe:

• Endoscopic ultrasound (hoʻāʻo e hoʻohana ai i kahi pae maʻalahi a me nā nalu kani e nānā i nā ʻōnaehana digestive)
• ʻO ka scanna Octreotide (kahi hoʻāʻo kūikawā e nānā ai no nā hunaola kikoʻī kikoʻī i loko o ke kino)
• Pancreatic arteriography (hoʻāʻo e hoʻohana i ka kala kala kūikawā e ʻike i nā aʻa i loko o ka pancreas)
• ʻO ka pancreatic venous sampling no ka insulin (hōʻike e kōkua i ka loaʻa ʻana o kahi kokoke o ka tumo i loko o ka pancreas)

ʻO ke kaha keʻoki maʻamau no ka insulinoma. Inā loaʻa kahi tumo hoʻokahi, e hemo ia. Inā nui nā tumors, pono e hemo ʻia kahi ʻāpana o ka pancreas. Ma ka liʻiliʻi he 15% o nā pancreas e waiho e hana i nā pae maʻamau o nā enzymes no ka digestion.

I nā hihia maʻamau, wehe ʻia ka pancreas holoʻokoʻa inā nui nā insulinomas a i ʻole hoʻomau lākou e hoʻi. ʻO ka wehe ʻana i ka pancreas āpau e alakaʻi aku ai i ka maʻi diabetes no ka mea ʻaʻohe mea e hana hou ʻia ana kahi insulin. ʻO nā pana insulina (injection) a laila koi ʻia.

Inā loaʻa ʻole kahi tumo i ka wā o ke ʻoki ʻana, a inā ʻaʻole hiki iā ʻoe ke ʻoki ʻia, loaʻa paha iā ʻoe ka lāʻau diazoxide e hoʻohaʻahaʻa ai i ka hana insulina a pale i ka hypoglycemia. Hāʻawi ʻia kahi pill wai (diuretic) me kēia lāʻau e pale ai i ke kino mai ka mālama ʻana i ka wai. ʻO Octreotide kekahi lāʻau i hoʻohana ʻia e hōʻemi i ka hoʻokuʻu o ka insulin i kekahi poʻe.

I ka hapanui o nā hihia, non-cancerous (tumomo) ka tumo, a hiki i ke kīpē ke hoola i ka maʻi. Akā ʻo ka hopena hypoglycemic koʻikoʻi a i ʻole ka hoʻolaha ʻana o kahi tumo maʻi ʻaʻai i nā mea ʻē aʻe hiki ke hoʻoweliweli i ke ola.

Komo pū nā pilikia:

• ʻO ka hopena hypoglycemic koʻikoʻi
• Hoʻolahalaha ʻia kahi tumo maʻi ʻaʻai (metastasis)
• ʻO ka maʻi diabetes inā hemo ka pancreas holoʻokoʻa (kākaʻikahi), a i ʻole ʻai ʻia ka meaʻai inā hemo ka nui o ka pancreas
• ʻO ka wela a me ka pehu o ka pancreas

Kāhea i kāu mea mālama ola inā hoʻomohala ʻoe i nā ʻōuli o ka insulinoma. ʻO ka hopu ʻana a me ka lilo ʻana o ka ʻike i kahi wā pilikia. Kāhea iā 911 a i ʻole ka helu kūloko kūloko koke.

Insulinoma; Islet cell adenoma, Pancreatic neuroendocrine hikoko; Hypoglycemia - insulinoma

• Nānā Endocrine
• Hoʻokuʻu ka meaʻai a me ka insulin

ʻO Asban A, Patel AJ, Reddy S, Wang T, Balentine CJ, Chen H. Cancer o ka ʻōnaehana endocrine. I: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. ʻO Oncology Clinical ʻo Abboff. ʻElua huaʻōlelo Piladelapia, PA: Elsevier; 2020: chap 68.

Pūnaewele Pūnaewele Manuahi Manuahi. Nā kulekele hana hoʻokolohua NCCN i ka oncology (nā alakaʻi NCCN): Neuroendocrine a me nā tumora adrenal. Mana 2.2020. www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf. Hoʻohou i Iulai 24, 2020. Loaʻa iā Nowemapa 11, 2020.

ʻO Strosberg JR, Al-Toubah T. Neuroendocrine tumors. I: Feldman M, Friedman LS, Brandt LJ, eds. ʻO Sleisenger a me Fordtran's Gastrointestinal a me ka maʻi ate. 11th hua. Piladelapia, PA: Elsevier; 2021: chap 34.