Forty-eight-hour fast: The diagnostic test for insulinoma
Forty-eight-hour fast: The diagnostic test for insulinoma
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DOI：
10.1210/jc.85.9.3222
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发表时间：
2000-09-01
影响因子：
5.8
通讯作者：
Gorden, P
中科院分区：
文献类型：
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作者：
Hirshberg, B;Livi, A;Gorden, P
胰岛素瘤由于不适当的胰岛素分泌而引起空腹低血糖。它的诊断是基于在监督72小时禁食期间显示维普莱三联征。75年来，72小时禁食一直是诊断的基石;然而，从未使用胰岛素、C肽和胰岛素原的新检测方法对其进行过严格评估。因此，本研究的目的是评估胰岛素瘤诊断是否需要禁食72小时。记录血糖浓度低于45 mg/dL的疑似低血糖患者入住NIH。在30年期间（1970-2000年），病理证实的胰岛素瘤患者的监督快速获得的数据进行了审查。我们确定了127例胰岛素瘤患者。患者的平均年龄为42.7 ± 15.9岁，女性占多数（62%）。良性肿瘤107例，恶性胰岛素瘤20例，多发性内分泌瘤1型15例。44例患者（42.5%）在12 h、85例患者（66.9%）在24 h和120例患者（94.5%）在48 h因低血糖终止禁食。7例患者禁食超过48小时，尽管有轻微的神经性低血糖症状，血糖和胰岛素浓度诊断为胰岛素瘤。免疫反应性胰岛素原升高，在开始的快速在90%的42例患者。与胰岛素瘤相反，非胰岛素瘤患者的胰岛素原通常是可抑制的;因此，在抑制状态下采集的样本具有最大的诊断价值。我们的结论是，目前可用的胰岛素和胰岛素原测定，胰岛素瘤的诊断可以在48小时内。因此，48小时禁食应取代教科书和医院协议中的72小时禁食作为新的诊断标准。
Insulinoma causes fasting hypoglycemia due to inappropriate insulin secretion. Its diagnosis is based on demonstrating Whipple's triad during a supervised 72-h fast. For 75 yr, the 72-h fast has been the cornerstone for the diagnosis; however, it has never been critically assessed using newer assays for insulin, C peptide, and proinsulin. Thus, the aim of the current study is to assess the need for a full 72-h fast for the diagnosis of insulinoma. Patients with suspected hypoglycemia with documented glucose concentrations below 45 mg/dL were admitted to the NIH. Data obtained during the supervised fast of patients with pathologically proven insulinoma over a 30-yr period (1970-2000) were reviewed. We identified 127 patients with insulinoma. The average age of patients was 42.7 +/- 15.9 yr, with a predominance of females (62%). 107 patients had a benign tumor, 20 had malignant insulinoma, and 15 patients had multiple endocrine neoplasia type 1. The fast was terminated due to hypoglycemia in 44 patients (42.5%) by 12 h, 85 patients (66.9%) by 24 h, and 120 (94.5%) by 48 h. Seven patients fasted beyond 48 h despite subtle neuroglycopenic symptoms and glucose and insulin concentrations diagnostic of insulinoma. Immunoreactive proinsulin was elevated at the beginning of the fast in 90% of 42 patients. Proinsulin in noninsulinoma, in contrast to insulinoma, patients is usually suppressible; therefore, samples taken in the suppressed state have the greatest diagnostic value. We conclude that with the current available insulin and proinsulin assays, the diagnosis of insulinoma can be made within 48 h. Thus, the 48-h fast should replace the 72-h fast in textbooks and hospital protocols as the new diagnostic standard.