Insulinoma in a Patient with Chronic Renal Failure due to Type 2 Diabetes Mellitus Treated Effectively with Diazoxide

Shimizu, Masanori; Suzuki, Kunihiro; Tsuchida, Kenji; Kojima, Masaru; Hiraishi, Hideyuki; Aso, Yoshimasa

doi:10.2169/internalmedicine.54.3621

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…bid, twice a day; CSI, continuous subcutaneous injection; IV, intravenous; s.c, subcutaneous injection rather than diazoxide in our case that octreotide is metabolized predominantly in the liver and has been often used in hemodialysis patients. 10 We also showed that the use of octreotide in CSI avoided gastrointestinal symptoms compared with BSI. While the actual mechanism is still unknown, we believe the symptoms are related to peak plasma concentrations.…”

Section: F I G U R Ementioning

confidence: 64%

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Successful treatment of adult‐onset nesidioblastosis by continuous subcutaneous octreotide infusion in a patient on hemodialysis

Kato

Nishimura

Matsumura

et al. 2020

Clinical Case Reports

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Section: F I G U R Ementioning

confidence: 64%

“…Especially, there are few reports about adult‐onset NIPHS with nesidioblastosis treated with CSI of octreotide. It was for these reasons we chose octreotide rather than diazoxide in our case that octreotide is metabolized predominantly in the liver and has been often used in hemodialysis patients 10 …”

Section: Discussionmentioning

confidence: 99%

Successful treatment of adult‐onset nesidioblastosis by continuous subcutaneous octreotide infusion in a patient on hemodialysis

Kato

Nishimura

Matsumura

et al. 2020

Clinical Case Reports

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“…There exist only four cases reported of patients with hyperinsulinemic hypoglycemia and chronic kidney disease that we are aware of. After diagnostic evaluation, the four of them were found to be insulinomas [6, 14, 17, 18].…”

Section: Discussionmentioning

confidence: 99%

Adult Nesidioblastosis in Chronic Kidney Disease

Lozano-Melendez

Aguilar-Soto

Graniel-Palafox

et al. 2019

Case Reports in Endocrinology

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Context. Nesidioblastosis is a rare cause of hyperinsulinemic hypoglycemia in adults. The diagnosis is further complicated in patients with kidney failure, since impaired renal function can cause hypoglycemia by itself and diagnostic criteria for this clinical scenario have not been developed yet. Case Description. We present the case report of a 36-year-old patient with end stage chronic kidney disease who presented to the emergency department because of hypoglycemia. However, the patient’s hypoglycemia did not respond well to medical treatment; the diagnosis of hyperinsulinemic hypoglycemia was made due to the presence of inappropriately high levels of insulin, proinsulin, and C-peptide during an episode of hypoglycemia. Imaging studies were performed without any conclusive findings; so selective intra-arterial pancreatic stimulation with hepatic venous sampling (SACTS) was done. Based on the results of this study the patient was referred for subtotal pancreatectomy. Classic criteria for the diagnosis of insulinoma with SACTS required a 2-fold increase in insulin levels but newer criteria suggest thresholds that are useful in the differential diagnosis of insulinoma and nesidioblastosis. In our patient, the former criteria were positive; however, the new criteria were not compatible with insulinoma but with nesidioblastosis, which was the final histopathological diagnosis. Conclusion. This seems to be the first case report of a patient with end stage chronic kidney disease and nesidioblastosis, as well as the first case of hyperinsulinemic hypoglycemia in the context of kidney failure diagnosed by SACTS. We consider this method to be very useful in patients with renal impairment because peripancreatic insulin levels do not depend on the renal function.

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“…Studies have indicated that type II diabetes frequently leads to chronic renal failure due to long-term insulin injection and disturbance of carbohydrate metabolism ( 35 , 36 ). In addition, in patients with chronic renal failure induced by type II diabetes mellitus present insulinoma treatment with diazoxide is ineffective ( 37 ). Furthermore, type II diabetes-induced chronic renal failure leads to other clinical syndromes and increases mortality ( 38 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

Resveratrol provides benefits in mice with type II diabetes‑induced chronic renal failure through AMPK signaling pathway

Guo

Zhang

2018

Exp Ther Med

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Type II diabetes-induced ischemic injuries are known to lead to the rapid degeneration of the kidneys as a result of chronic renal failure. Chronic renal failure is a condition, which typically manifests with symptoms including cardiovascular system and left ventricular hypertrophy, atherosclerosis as well as arterial and aortic stiffness. Resveratrol is a multifunctional compound that has been reported to produce beneficial outcomes for patients with type-II diabetes due to prevention of oxidative stress and apoptosis. However, the beneficial effects of resveratrol in chronic renal failure and the underlying mechanisms have remained to be fully elucidated. The present study investigated the therapeutic effects of resveratrol in mice with chronic renal failure induced by type-II diabetes and assessed the mechanism of action. Oxidative stress, apoptosis and adenosine monophosphate-activated protein kinase (AMPK) in the renal cells of the model mice were assessed. Changes in inflammatory factors renal cells from experimental mice as well as insulin resistance were also analyzed. Morphological changes and immunocytes in renal cells were determined by immunostaining. The results demonstrated that resveratrol treatment decreased the apoptotic rate of renal cells from experimental mice. Oxidative stress also improved in renal cells, as indicated by inhibition of superoxide dismutase and reduced glutathione and 4-hydroxy-2-nonenal levels. In addition, insulin resistance was improved after an 8-week treatment with resveratrol. Inflammatory factors were decreased and factors promoting kidney function were increased after resveratrol treatment. Furthermore, morphological changes were observed to be ameliorated, indicating the therapeutic efficacy of resveratrol. In addition, immunocyte precipitation in renal cells was markedly decreased in resveratrol-treated mice. Importantly, the AMPK signaling pathway was found to be involved in the beneficial effect of resveratrol on the model mice. In conclusion, the present study suggested that resveratrol may be an ideal agent for the treatment of chronic renal failure induced by type-II diabetes through regulation of the AMPK signaling pathway, which should be further investigated in clinical trials.

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Insulinoma in a Patient with Chronic Renal Failure due to Type 2 Diabetes Mellitus Treated Effectively with Diazoxide

Cited by 10 publications

References 17 publications

Successful treatment of adult‐onset nesidioblastosis by continuous subcutaneous octreotide infusion in a patient on hemodialysis

Successful treatment of adult‐onset nesidioblastosis by continuous subcutaneous octreotide infusion in a patient on hemodialysis

Adult Nesidioblastosis in Chronic Kidney Disease

Resveratrol provides benefits in mice with type II diabetes‑induced chronic renal failure through AMPK signaling pathway

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