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10.1530/EC-17-0076 http://scihub22266oqcxt.onion/10.1530/EC-17-0076 C5597976!5597976!28784625     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=28784625&cmd=llinks): Failed to open stream: HTTP request failed! 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Adult-onset hyperinsulinaemic hypoglycaemia in clinical practice: diagnosis, aetiology and management |pdf=|usr=}}{{28784625}} gab.com Text Adult-onset hyperinsulinaemic hypoglycaemia in clinical practice: diagnosis, aetiology and management JO: Endocr Connect http://www.kidney.de/pget.php?&tw=1&pmid=28784625 #FOAvip Objective: In adults with hyperinsulinaemic hypoglycaemia (HH), in particular those with insulinoma, the optimal diagnostic and management strategies remain uncertain. Here, we sought to characterise the biochemical and radiological assessment, and clinical management of adults with HH at a tertiary centre over a thirteen-year period. Design: Clinical, biochemical, radiological and histological data were reviewed from all confirmed cases of adult-onset hyperinsulinaemic hypoglycaemia at our centre between 2003 and 2016. In a subset of patients with stage I insulinoma, whole-exome sequencing of tumour DNA was performed. Results: Twenty-nine patients were identified (27 insulinoma, including 6 subjects with metastatic disease; 1 pro-insulin/GLP-1 co-secreting tumour; 1 activating glucokinase mutation). In all cases, hypoglycaemia (glucose ?2.2?mmol/L) was achieved within 48?h of a supervised fast. At fast termination, subjects with stage IV insulinoma had significantly higher insulin, C-peptide and pro-insulin compared to those with insulinoma staged I?IIIB. Preoperative localisation of insulinoma was most successfully achieved with EUS. In two patients with inoperable, metastatic insulinoma, peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE rapidly restored euglycaemia and lowered fasting insulin. Finally, in a subset of stage I insulinoma, whole-exome sequencing of tumour DNA identified the pathogenic Ying Yang-1 (YY1) somatic mutation (c.C1115G/p.T372R) in one tumour, with all tumours exhibiting a low somatic mutation burden. Conclusion: Our study highlights, in particular, the utility of the 48-h fast in the diagnosis of insulinoma, EUS for tumour localisation and the value of PRRT therapy in the treatment of metastatic disease. Twit Text FOAVip Adult-onset hyperinsulinaemic hypoglycaemia in clinical practice: diagnosis, aetiology and management ????Endocr Connect http://www.kidney.de/pget.php?&tw=1&pmid=28784625 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=28784625 #FOAvip English Wikipedia <ref>{{Cite pmid|28784625}}</ref> Adult-onset hyperinsulinaemic hypoglycaemia in clinical practice: diagnosis, aetiology and management #MMPMID28784625 Challis BG; Powlson AS; Casey RT; Pearson C; Lam BY; Ma M; Pitfield D; Yeo GSH; Godfrey E; Cheow HK; Chatterjee VK; Carroll NR; Shaw A; Buscombe JR; Simpson HL Endocr Connect 2017[Oct]; 6 (7): 540-8 PMID28784625show ga Objective: In adults with hyperinsulinaemic hypoglycaemia (HH), in particular those with insulinoma, the optimal diagnostic and management strategies remain uncertain. Here, we sought to characterise the biochemical and radiological assessment, and clinical management of adults with HH at a tertiary centre over a thirteen-year period. Design: Clinical, biochemical, radiological and histological data were reviewed from all confirmed cases of adult-onset hyperinsulinaemic hypoglycaemia at our centre between 2003 and 2016. In a subset of patients with stage I insulinoma, whole-exome sequencing of tumour DNA was performed. Results: Twenty-nine patients were identified (27 insulinoma, including 6 subjects with metastatic disease; 1 pro-insulin/GLP-1 co-secreting tumour; 1 activating glucokinase mutation). In all cases, hypoglycaemia (glucose ?2.2?mmol/L) was achieved within 48?h of a supervised fast. At fast termination, subjects with stage IV insulinoma had significantly higher insulin, C-peptide and pro-insulin compared to those with insulinoma staged I?IIIB. Preoperative localisation of insulinoma was most successfully achieved with EUS. In two patients with inoperable, metastatic insulinoma, peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE rapidly restored euglycaemia and lowered fasting insulin. Finally, in a subset of stage I insulinoma, whole-exome sequencing of tumour DNA identified the pathogenic Ying Yang-1 (YY1) somatic mutation (c.C1115G/p.T372R) in one tumour, with all tumours exhibiting a low somatic mutation burden. Conclusion: Our study highlights, in particular, the utility of the 48-h fast in the diagnosis of insulinoma, EUS for tumour localisation and the value of PRRT therapy in the treatment of metastatic disease. äAdult-onset hyperinsulinaemic hypoglycaemia in clinical practice: diag(epmc).pdf DeepDyve Pubget Overpricing