{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T16:17:05Z","timestamp":1686932225019},"reference-count":37,"publisher":"Akademiai Kiado Zrt.","issue":"35","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,8,1]]},"abstract":"<jats:p>A nem insulinoma eredet\u0171 tart\u00f3s (perziszt\u00e1l\u00f3) hyperinsulinaemi\u00e1val j\u00e1r\u00f3 hypoglykaemia oka a feln\u0151ttek k\u00f6r\u00e9ben ritk\u00e1n el\u0151fordul\u00f3 nesidioblastosis. A nesidioblastosis h\u00e1tter\u00e9ben \u00e1ll\u00f3 inzulinszekr\u00e9ci\u00f3s zavar molekul\u00e1ris elt\u00e9r\u00e9seken alapul. Morfol\u00f3giailag k\u00fcl\u00f6nb\u00f6z\u0151 pancreassziget-, illetve b\u00e9ta-sejt-elt\u00e9r\u00e9sek jellemzik, az inzulinhiperszekr\u00e9ci\u00f3 h\u00e1tter\u00e9ben azonban k\u00f6r\u00fclhat\u00e1rolhat\u00f3 t\u00e9rfoglal\u00e1s nem mutathat\u00f3 ki. A diagn\u00f3zis alappill\u00e9re az alacsony v\u00e9rcukorszint, a normoglykaemia intrav\u00e9n\u00e1san alkalmazott gl\u00fck\u00f3z ad\u00e1s\u00e1val t\u00f6rt\u00e9n\u0151 fenntarthat\u00f3s\u00e1ga, illetve az emelkedett inzulin- \u00e9s C-peptid-szint. A hormontermel\u0151 tumor kiz\u00e1r\u00e1s\u00e1hoz mind invaz\u00edv, mind nem invaz\u00edv k\u00e9palkot\u00f3 m\u00f3dszerek sz\u00fcks\u00e9gesek. A tart\u00f3s, illetve ism\u00e9tl\u0151d\u0151 hypoglykaemia k\u00e1ros hat\u00e1sai gy\u00f3gyszeres \u00e9s\/vagy seb\u00e9szi kezel\u00e9ssel el\u0151zhet\u0151k meg. \n <jats:italic>Esetismertet\u00e9s:<\/jats:italic>\n A szerz\u0151k k\u00e9t beteg\u00fck eset\u00e9t ismertetik, akikn\u00e9l feln\u0151ttkorban jelentkeztek a s\u00falyos t\u00fcnetekkel j\u00e1r\u00f3 hypoglykaemi\u00e1s epiz\u00f3dok. N\u0151beteg\u00fck \u201eklasszikus\u201d hypoglykaemi\u00e1s t\u00fcnetei 34 \u00e9ves korban l\u00e9ptek fel: izzad\u00e1s, sz\u00e9d\u00fcl\u00e9s, remeg\u00e9s, idegess\u00e9g, illetve \u00e9letvesz\u00e9lyes neuroglycopeni\u00e1s jelek. M\u00e1sodik, f\u00e9rfi beteg\u00fck 22 \u00e9ves, akinek f\u0151 panasza a hypoglykaemia ritka \u00e9s szokatlan t\u00fcnete, a nagyfok\u00fa \u00e9hs\u00e9g\u00e9rzet mellett jelentkez\u0151 puffad\u00e1s volt. Az \u00e9hez\u00e9si pr\u00f3b\u00e1k mindk\u00e9t esetben pozit\u00edvak voltak, vagyis hypoglykaemi\u00e1s t\u00fcnetek miatt fel kellett azokat f\u00fcggeszteni. Az inzulin- \u00e9s a C-peptid-szintek magasak voltak, v\u00e9n\u00e1s inzulinszint-meghat\u00e1roz\u00e1s az a. lienalis t\u00f6bb pontj\u00e1b\u00f3l \u00e9s a k\u00e9palkot\u00f3 elj\u00e1r\u00e1sok (komputertomogr\u00e1fia, m\u00e1gneses rezonancia, pozitronemisszi\u00f3s tomogr\u00e1fia, angiogr\u00e1fia) nem tudtak igazolni t\u00e9rfoglal\u00e1st. Az adatok alapj\u00e1n \u2013 sz\u00f6vettan hi\u00e1ny\u00e1ban is \u2013 a legval\u00f3sz\u00edn\u0171bb a feln\u0151ttkori nesidioblastosis diagn\u00f3zisa. Diazoxid ad\u00e1s\u00e1val mindk\u00e9t esetben majdnem teljes t\u00fcnetmentess\u00e9get \u00e9rtek el, \u00e9s neuroglycopeni\u00e1s esem\u00e9ny a kezel\u00e9s kezdete \u00f3ta nem fordult el\u0151. \n <jats:italic>K\u00f6vetkeztet\u00e9sek:<\/jats:italic>\n Ismeretlen eredet\u0171 hypoglykaemia eset\u00e9n, ha a k\u00e9palkot\u00f3 elj\u00e1r\u00e1sokkal nincs k\u00f6r\u00fcl\u00edrt k\u00e9plet, a laborat\u00f3riumi adatok viszont egy\u00e9rtelm\u0171en emelkedett inzulinszekr\u00e9ci\u00f3ra utalnak, gondolni kell nesidioblastosis lehet\u0151s\u00e9g\u00e9re. A seb\u00e9szi beavatkoz\u00e1s vesz\u00e9lye pancreasel\u00e9gtelens\u00e9g \u00e9pp\u00fagy lehet, mint a betegs\u00e9g fennmarad\u00e1sa a hasny\u00e1lmirigy reszekci\u00f3ja miatt. Diazoxid ad\u00e1s\u00e1val viszont tart\u00f3s t\u00fcnetmentess\u00e9g \u00e9rhet\u0151 el ezen ritka k\u00f3rk\u00e9pben, ez\u00e9rt \u00e9rdemes els\u0151k\u00e9nt ezt megk\u00eds\u00e9relni.<\/jats:p>","DOI":"10.1556\/oh.2008.28399","type":"journal-article","created":{"date-parts":[[2008,8,20]],"date-time":"2008-08-20T02:42:46Z","timestamp":1219200166000},"page":"1659-1664","source":"Crossref","is-referenced-by-count":5,"title":["Hyperinsulinemic hypoglycemia in adults. Case reports and a short review"],"prefix":"10.1556","volume":"149","author":[{"given":"Erzs\u00e9bet","family":"Kov\u00e1cs","sequence":"first","affiliation":[{"name":"1 Debreceni Egyetem, Orvos- \u00e9s Eg\u00e9szs\u00e9gtudom\u00e1nyi Centrum Belgy\u00f3gy\u00e1szati Int\u00e9zet, II. Belgy\u00f3gy\u00e1szati Klinika, Ritka Betegs\u00e9gek Tansz\u00e9k Debrecen Nagyerdei krt. 98. 4032"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajnalka","family":"N\u00e9meth","sequence":"additional","affiliation":[{"name":"1 Debreceni Egyetem, Orvos- \u00e9s Eg\u00e9szs\u00e9gtudom\u00e1nyi Centrum Belgy\u00f3gy\u00e1szati Int\u00e9zet, II. Belgy\u00f3gy\u00e1szati Klinika, Ritka Betegs\u00e9gek Tansz\u00e9k Debrecen Nagyerdei krt. 98. 4032"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c9va","family":"P\u00e1sztor","sequence":"additional","affiliation":[{"name":"2 Debreceni Egyetem, Orvos- \u00e9s Eg\u00e9szs\u00e9gtudom\u00e1nyi Centrum Belgy\u00f3gy\u00e1szati Int\u00e9zet, Radiol\u00f3giai Klinika Debrecen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gy\u00f6rgy","family":"Pfliegler","sequence":"additional","affiliation":[{"name":"1 Debreceni Egyetem, Orvos- \u00e9s Eg\u00e9szs\u00e9gtudom\u00e1nyi Centrum Belgy\u00f3gy\u00e1szati Int\u00e9zet, II. Belgy\u00f3gy\u00e1szati Klinika, Ritka Betegs\u00e9gek Tansz\u00e9k Debrecen Nagyerdei krt. 98. 4032"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"atypb1","first-page":"125","volume":"14","year":"1938","journal-title":"Am. J. 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