Glucose controlled insulin infusion system (Biostator) application during surgery for a presumed pancreatic microinsulinoma

Area of Science:

• Endocrinology
• Surgical Management
• Metabolic Disorders

Background:

• Organic hyperinsulinism can lead to dangerous blood glucose fluctuations.
• Surgical resection is the primary treatment, but intraoperative management is challenging.
• Accurate glucose monitoring and insulin delivery are crucial for patient stability.

Purpose of the Study:

• To evaluate the efficacy of a glucose-controlled insulin infusion system in managing a patient with organic hyperinsulinism during and after surgery.
• To assess the system's role in monitoring metabolic changes and guiding treatment.
• To investigate the potential for microinsulinoma resection despite initial negative histology.

Main Methods:

• Utilized a glucose-controlled insulin infusion system for real-time blood glucose monitoring and insulin delivery.
• Administered intravenous glucose infusion post-surgery to maintain caloric and fluid intake.
• Monitored plasma insulin levels and glycaemic responses to intravenous glucose loads.

Main Results:

• The system effectively managed blood glucose levels during surgery, avoiding insulin hypersecretion.
• A correlation between surgical procedures and metabolic behavior suggested successful microinsulinoma resection.
• Post-surgery, gradual recovery of pancreatic tissue activity was evidenced by decreasing insulin requirements and normalized glucose/insulin responses.

Conclusions:

• Glucose-controlled insulin infusion systems are valuable tools for managing organic hyperinsulinism perioperatively.
• The system aids in detecting subtle metabolic changes and assessing residual pancreatic function.
• This case highlights the potential for successful surgical management of microinsulinoma.