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Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection

  • Endocrine Surgery
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Abstract

Purpose

It has been proposed that rebound hyperglycemia after resection of insulinoma indicates a biochemical cure. However, there is scant objective data in the literature on the rate and need for intervention in hyperglycemia in patients undergoing resection of insulinoma. The goal of our study was to evaluate the rate of postoperative hyperglycemia, any predisposing factors, and the need for intervention in a prospective cohort study of all patients undergoing routine glucose monitoring.

Methods

A retrospective analysis of 33 patients who had an insulinoma resected and who underwent routine postoperative monitoring of blood glucose (every hour for the first six hours then every four hours for the first 24 h) was performed. Hyperglycemia was defined as glucose greater than 180 mg/dL (10 mmol/l).

Results

Twelve patients (36%) developed hyperglycemia within 24 h (range 1–16 h). In patients with hyperglycemia, the mean maximum plasma glucose level was 221.5 mg/dL (range 97–325 mg/dL) (12.3 mmol/l), and four (33%) patients were treated with insulin. There was no significant difference in age, gender, body mass index (BMI), tumor size, biochemical profile, or surgical approach and extent of pancreatectomy between patients who developed hyperglycemia and those who did not. Pre-excision and post-excision intraoperative insulin levels were evaluated in 14 of 33 patients. The percentage decrease of the intraoperative insulin levels was not significantly different between patients who developed hyperglycemia and those who did not. All patients with postoperative hyperglycemia had normalization of their glucose levels, and none were discharged on anti-hyperglycemic agents.

Conclusions

Hyperglycemia is common after insulinoma resection, and a subset of patients require transient treatment with insulin.

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Funding

Intramural Research Program, National Cancer Institute, National Institutes of Health.

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Authors and Affiliations

  1. Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Pavel Nockel, Amit Tirosh, Mustapha El Lakis, Roxanne Merkel, Dhaval Patel & Naris Nilubol

  2. Presbyterian Medical Group, Endocrine Surgery, Albuquerque, NM, USA

    Pavel Nockel

  3. NET service, Sheba MC, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Amit Tirosh

  4. Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, Alexandroupoli, Greece

    Apostolos Gaitanidis

  5. Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland

    Samira M. Sadowski

  6. The National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

    Craig Cochran & Phillip Gorden

  7. Department of Surgery, Surgery and Cancer Center, Stanford University School of Medicine, Stanford, CA, USA

    Electron Kebebew

Authors
  1. Pavel Nockel
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  2. Amit Tirosh
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  9. Craig Cochran
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  11. Electron Kebebew
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Correspondence to Electron Kebebew.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Nockel, P., Tirosh, A., El Lakis, M. et al. Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection. Endocrine 61, 422–427 (2018). https://doi.org/10.1007/s12020-018-1633-1

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  • DOI: https://doi.org/10.1007/s12020-018-1633-1

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