胰岛素瘤长期误诊癫痫发作一例并文献复习

Insulinoma Misdiagnosed as Epilepsy in a Long-term: One Case Report and Literature Review

目的探讨胰岛素瘤致脑损害的临床特点及鉴别诊断,减少误诊误治。方法回顾分析1例长期误诊为癫痫的胰岛素瘤的临床资料,并复习相关文献。结果本例以行为异常、精神错乱、昏睡、智力低下8年为主要临床表现,长期在外院诊断为癫痫。此次以昏迷2 d入院,入院后2次查低血糖发作时血糖2.75、1.71 mmol/L,血清胰岛素24.71、156.36 m U/L,胰岛素/血糖比值0.50、5.08,糖耐量试验阳性,胰腺增强CT示胰腺肿瘤,颅脑CT检查示脑萎缩,修正诊断为胰岛素瘤并脑萎缩。转外科行手术切除肿瘤,病理检查证实诊断。术后血糖恢复正常。结论胰岛素瘤所致低血糖可以中枢神经损害症状为表现,临床上对此类临床表现不典型的胰岛素瘤应引起重视,避免误诊。

Objective To explore the clinical characteristics and differential diagnosis of insulinomas induced brain damage,reduce misdiagnoses. Methods A retrospective analysis of clinical data of 1 case of insulinoma misdiagnosed as schizophrenia was made,and the literature was reviewed. Results The patient with the main clinical expression of abnormal behavior,confusion,lethargy and mental retardation for 8 years had been diagnosised as schizophrenia before admission to our hospital,and had not been given any regular treatment. This time,the patient was admitted to our hospital for lethargy for 2days. After admission,two tests of hypoglycemia were conducted and showed that her blood sugar was 2. 75 mmol / L,1. 71 mmol / L and serum insulin was 24. 71,156. 36 m U / L,and the insuline / blood sugar ratio was 0. 50,5. 08,and glucose tolerance test was positive. Pancreatic enhancement of CT showed a pancreatic tumor. Brain CT showed cerebral atrophy. Diagnosis of insulinoma and cerebral atrophy were diagnosed after revision. Transfer line surgical operation was performed to remove tumor and pathologic examination confirmed the diagnosis. Postoperative blood glucose returned to normal,and the condition was improved. Conclusion Hypoglycemia induced by insulinoma can be manifested by symptoms in central nervous system damage. For such atypical clinical presentation of insulinoma,attention should be paid to prevent misdiagnosis as epilepsy,hysteria and other mental disorders.