- 症例報告齋藤新介 1, 長坂昌一郎 1, 齋藤奈緒子 1, 松田蓉子 1, 高橋学 1, 岡田修和 1, 岡田健太 1, 野牛宏晃 12, 大須賀淳一 1 1, 石橋俊 - - 要約 / /. ng/ml. U/ml / / / / 諸言 Continuous glucose monitor

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1 - 症例報告齋藤新介 1, 長坂昌一郎 1, 齋藤奈緒子 1, 松田蓉子 1, 高橋学 1, 岡田修和 1, 岡田健太 1, 野牛宏晃 12, 大須賀淳一 1 1, 石橋俊 - - 要約 / /.ng/ml.u/ml / / // 諸言 Continuous glucose monitoring CGM CGM 症例患者主訴既往歴家族歴現病歴 /HbAcNGSP..U/ml - - shin-sai@jichi.ac.jp

CGM /.ng/ml. U/ml 当科転科時内服 (1 日量 ). 転科時現症..BMI. kg/m 表 1 検査データ WBC /l T.P.g/dl RBC /l Alb.g/dl Hb./dl BUN mg/dl Plt./l Cre.mg/dl AST mu/ml PT. ALT mu/ml PT-INR. LDH mu/ml APTT. ALP mu/ml T.Bil.

2 CGM /.ng/ml. U/ml 当科転科時内服 (1 日量 ). 転科時現症..BMI. kg/m 表 1 検査データ WBC /l T.P.g/dl RBC /l Alb.g/dl Hb./dl BUN mg/dl Plt./l Cre.mg/dl AST mu/ml PT. ALT mu/ml PT-INR. LDH mu/ml APTT. ALP mu/ml T.Bil.mg/dl /dl CK mu/ml HbAcNGSP.% Na mmol/l.% K.mmol/l,-AG.g/ml Cl mmol/l Ca.mg/dl P.mg/dl GH.ng/ml IGF- ng/ml ACTH.pg/ml Cortisol.g/dl TSH.U/ml F-T.ng/dl PRL.ng/ml intact PTH pg/ml. nu/ml mg/dl,cpr.ng/ml,iri.u/ml mg/dl,cpr.ng/ml,iri.u/ml,.pmol/l mg/dl,cpr.ng/ml,iri.u/ml mg/dl,cpr.ng/ml,iri.u/ml / mmhg/ Levine / 検査所見 ( 表 1) PT-INRAST ALTHbAcNGSP.. intact PTH CT 図 1 膵ダイナミック造影 CT 経過 Grunt //U/ml. FajansU/ml/ /.Turner U/ml// Turner ServiceU/ml.ng/ml

3 - 図 2A ジアゾキシド治療前 CGM mg/dlmg/dl 図 2B ジアゾキシド内服開始当日のCGM mg/dl mg/dl MRI ASVS CGMMedtronic MINIMED CGMS system gold MiniMed Solution CGMS Sensor / / /./ / /./ // /./.. HbAc / HbAcNGSP. // 考察

4 CGM 図 2C,D ジアゾキシド内服開始後 5 日目 (C),6 日目 (D) のCGM // // 図 2E 退院前のCGM /mg/dl mg/dl

5 - ATP Ca + Ca +, CGM Munir CGM / /./ /. /./ Gill / / BMI./ /././ / CGM CGM CGM ZijlstaCGM absolute relative difference CGMSMBG /SMBG./.CGM. CT 文献 Vaidakis D, Karoubalis J, Pappa T, et al Pancreatic insulinoma current issues and trends. Hepatobiliary Pancreat Dis Int - Vaddiraju S, Burgess DJ, Tomazos I, et al Technologies for continuous glucose monitoring current problems and future promises. Journal of Diabetes Science and Technology - Munir AChoudary PHarrison B, et al Continuous glucose monitoring in patients with insulinoma. Clin Endocrinol Oxf- - - Gill GV, Rauf O, MacFarlance IA Diazoxide treatment for insulinoma a national UK survey. Postgrad Med J - Zijistra E, Heise T, Nosek L, et al Continuous glucose monitoringquality of hypoglycaemia detection. Diabetes Obesity Metab -

6 Jichi Medical University Journal - A case of insulinoma in which the therapeutic efficacy of diazoxide was evaluated with continuous glucose monitoring Shinsuke Saito, Shoichiro Nagasaka, Naoko Saito, Yoko Matuda, Manabu Takahashi, Nobukazu Okada, Kenta Okada, Hiroaki Yagyu,, Jun-ichi Osuga, Shun Ishibashi Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi, Japan Present address Department of Endocrinology and Metabolism, Mito Kyodo General Hospital, Ibaraki, Japan Abstract A -year-old man was admitted to our hospital with convulsions. He displayed hypoglycemia with glucose levels of mg/dl on capillary glucose measurement. He was diagnosed with insulinoma, based on biochemical data of elevated serum insulin.u/mland C-peptide. ng/mllevels with a concomitant plasma glucose level of mg/dl. Because his mental retardation was so severe that he never stayed still, we were unable to perform magnetic resonance imaging, endoscopic ultrasonography, or selective arterial calcium injection testing to localize the tumor. Medical treatment with diazoxide was started, and efficacy was monitored with a continuous glucose-monitoring device. The initial dose of diazoxide was set to mg/day however, glucose levels remained low during the first two days. After the dose of diazoxide was increased to mg/day on day, glucose levels were elevated over mg/dl. A -mg/day dose was determined as the minimum effective dose to avoid hypoglycemia. In conclusion, continuous glucose monitoring is useful to evaluate the efficacy of diazoxide in a patient with insulinoma. Key Words insulinomacontinuous glucose monitoring diazoxide Correspondence toshinsuke Saito, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi, Japan, -, shin-sai@jichi.ac.jp Received September, Accepted November

- 症例報告 black adenoma Cushing 高橋学 1, 長坂昌一郎 1, 小太刀豪 1, 若林徹治 1, 齋藤奈緒子 1, 野口仁麗 1, 岡田健太 1, 今田浩生 2, 福嶋敬宜 2, 佐久間康成 3, 佐田尚宏 3 1, 石橋俊 - - 要約 Cushing ACTH mm C

- 症例報告 black adenoma Cushing 高橋学 1, 長坂昌一郎 1, 小太刀豪 1, 若林徹治 1, 齋藤奈緒子 1, 野口仁麗 1, 岡田健太 1, 今田浩生 2, 福嶋敬宜 2, 佐久間康成 3, 佐田尚宏 3 1, 石橋俊 - - 要約 CushingACTH mmcushing MIBG black adenomamibg black adenoma black adenoma

- 症例報告 齋藤新介 1, 長坂昌一郎 1, 齋藤奈緒子 1, 松田蓉子 1, 高橋学 1, 岡田修和 1, 岡田健太 1, 野牛宏晃 12, 大須賀淳一 1 1, 石橋俊 - - 要 約 / /. ng/ml. U/ml / / / / 諸言 Continuous glucose monitor

- 症例報告齋藤新介 1, 長坂昌一郎 1, 齋藤奈緒子 1, 松田蓉子 1, 高橋学 1, 岡田修和 1, 岡田健太 1, 野牛宏晃 12, 大須賀淳一 1 1, 石橋俊 - - 要約 / /. ng/ml. U/ml / / / / 諸言 Continuous glucose monitor