d****y
发帖数: 2180 | 1 ☆─────────────────────────────────────☆
zhu84518 (lot) 于 (Wed Aug 8 22:41:34 2012, 美东) 提到:
A previously healthy 32-year-old woman who works as a nurse comes to the
emergency department because of a 3-week history of episodes of dizziness,
nausea, and profuse sweating that resolve with eating. She does not smoke.
She drinks four glasses of wine weekly. Vital signs are within normal limits
. Physical examination shows no abnormalities. While in the emergency
department, she becomes dizzy and... 阅读全帖 |
|
b******a
发帖数: 704 | 2 Failure of endogenous insulin secretion to be suppressed by hypoglycemia is
the hallmark of an insulinoma. Thus, the finding of inappropriately elevated
levels of insulin in the face of hypoglycemia is the key to diagnosis. A
plasma insulin concentration of >3 microU/mL (20.8 pmol/L) when the plasma
glucose concentration is below 55 mg/dL (3.0 mmol/L) indicates an excess of
insulin and is consistent with insulinoma.
Plasma C-peptide distinguishes endogenous from exogenous hyperinsulinemia.
In p... 阅读全帖 |
|
b*******l
发帖数: 856 | 3 所以我建议她去查胰腺啊，以前见过这样的Insulinoma病人，这个要先排除了
因为Insulinoma的病人很容易被误认为癫痫，甲减和心律失常的病人啊！
护士学校业应该听说过这个病吧？ |
|
e*******a
发帖数: 246 | 4 normally c-peptide is elevated in insulinoma. But there are non-typical
insulinoma patients whose c-peptide level is relatively low; Please refer
to this case report: http://www.ncbi.nlm.nih.gov/pubmed/17146148 |
|
m****n
发帖数: 1066 | 5 insulinoma.
rare disease. |
|
t*****e
发帖数: 135 | 6 My mom was recently diagnosed with Insulinoma and Pheochromocytoma. I need
to consult surgeons here to get some opinions about surgeries options. Any
information or help would be highly appreciated.
Thanks. |
|
g***r
发帖数: 285 | 7
1
if you are for sure that they tested serum insulin level, then told him that
he would need insulin injection to control his diabetes because of the low
insulin level, then this is total BS,
there is absolutely no role in measuring plasma insulin level unless you are
looking for insulinoma; it has no value in diagnosing or monitoring
diabetes at all,
the second half of your question is a little complicated, simply put it,
type 1 diabetes are insulin dependent; for type 2, assume that's your fa |
|
b*******l
发帖数: 856 | 8 根据病史陈述，以前的检查，虽然不能100％的肯定诊断，但是一般不出这几个了。
第一：胰岛beta细胞瘤，Insulinoma，一般是良性瘤，不定时分泌胰岛素。检查方法： 腹部CT，内
分泌医生咨询。
第二：心律失常。
第三： 癫痫
第四：一切导致心律失常的病，主要查甲状腺。
强烈建议楼主去查胰腺。
希望以上分析对您有所帮助。 |
|
D********3
发帖数: 786 | 9 我对这个Insulinoma 不是很了解，但是要是这个病的话血糖会低吧，而且也会是
tachycardia。。而且b超也应该能看出
来，楼主不是血糖测试是好的，心率慢，而且腹部b超也没发现什么嘛。。不过也不排
除可能性 |
|
|
|
z**********4
发帖数: 467 | 12 Look like a insulinoma. |
|
h**s
发帖数: 1757 | 13 Should be E.
I do not think this is insulinoma b/c c- peptid and insulin are both normal.
This patient has several hypoglycemia. It can be from Addision's disease.
And for Addision's disease , common from pituitary disease. |
|
z**********4
发帖数: 467 | 14 Pure assumption:
C-peptide level can only be released by normal "islet cells". Insulinoma
does not contain normal "islet cells" which could not efficiently cleave pro
-insulin peptide to Cpeptide. Waiting for more evidence. |
|
J*********4
发帖数: 1274 | 15 Zhanghaowei4,
You are right! Insulinoma could have much higher proinsulin rather than
mature insulin, which might explain the borderline level of both insulin and
c-peptide level. |
|
h**s
发帖数: 1757 | 16 Do u have any paper to support your assumption? I could not find to support
this hypothesis.
If like you said, then it will be very confused Between insulinoma And
exagenous insulin abuse.
pro |
|
s********o
发帖数: 3319 | 17 大家懂太多了，所以喜欢联想翩翩。象我看一眼题就只能想起一个诊断，就是
insulinoma,然后毫不犹豫地选胰腺，再不会去看它一眼 LOL |
|
D*********t
发帖数: 140 | 18 I agree with hmis! First, the low limit of C peptide level together with a
high limit insulin level rules out insulinoma. This is because C peptide is
cleaved from proinsulin together with insulin and thus it should be always
parallel to the insulin level. Second, I think the possibility of pituitary
disease is the low level of cortisol. In hypoglycemia condition, cortisol
should be increased as response to stress. But cortisol in this patient is
still in low limit, indicating a failure to respo... 阅读全帖 |
|
i**********a
发帖数: 98 | 19 1.emma: Dream
What are u looking for?
fate
2. L-Path: must have step3,
who good for path—phd, research
CAF: need or not? Apply as many as you can
遇到不友好问题，不要 急，慢慢：I understand your concern, …不要太当回事
Program feedback, some very positive, still need to go for all iv,
态度：positive,投入，积极，一定能上
3. D-IM: how to get more iv，
现在就要找OB,专科的推荐信，
周末和晚上做，给60个人发，做了3个专科，as soon as possible.
Do want you can to improve the package
主动出击，联系已经match上的朋友，老板 朋友都 可以帮拿到，请别人递简历，练IV
，给program发email,早联系，发2-3遍，8月初就开始了，骚扰PC/PD，
4... 阅读全帖 |
|
z***q
发帖数: 175 | 20 今天去考试中心模拟考试，遇到这样一道题。虽然选对了（答案是c）但是没有clue。
觉得就是insulinoma，但不明白为什么insulin正常高值，c－peptide也不高。
大家来看看：
48. A previously healthy 32-year-old woman who
works as a nurse comes to the emergency
department because of a 3-week history of
episodes of dizziness, nausea, and profuse
sweating that resolve with eating. She does not
smoke. She drinks four glasses of wine weekly.
Vital signs are within normal limits. Physical
examination shows no abnormalities. While in
the emergency department, she becomes dizzy
a... 阅读全帖 |
|
|
z***q
发帖数: 175 | 22 看了描述的症状也觉得就是insulinoma，但能否解释一下为什么c-peptide不高？
insulin也处于正常高值。
谢谢 |
|
