So wote nka mpofirim sɛ wo ho yɛ nwini, wo ho fifiri, na wo tirim yɛ wo yaw? Ebetumi ayɛ insulinoma! Momma yɛnka eyi ho asɛm.

So woanya adwenemhaw mpofirim, wo tirim yɛ hare, na wo koma bɔ te sɛ bere a asikre a ɛwɔ wo mogya mu no so tew no pɛpɛɛpɛ pɛn? Ɛtɔ da bi a wususuw sɛ ɔkɔm de wo ara kwa nti na saa nneɛma yi te, nanso ɛntaa mma sɛ, biribi foforo betumi ama eyi aba. Ɛnnɛ, yɛrebɛka tebea bi a ɛntaa nsi nanso ɛho hia a ɛsɛ sɛ yɛma yɛn ani da hɔ ho asɛm. Ɛno yɛ tebea bi a wɔfrɛ no insulinoma.

Dɛn ne insulinoma yi?

Sɛ yɛbɛka no tiawa a, insulinoma yɛ akisikuru ketewaa bi a ɛnyɛ kokoram a ɛba yɛn dwensɔtwaa mu. Afei ebia woresusuw nea ɛyɛ dwensɔtwaa yi ho. Pancreas yɛ akwaa ketewaa bi nanso ɛho hia yiye a ɛwɔ yɛn yafunu mu, wɔ yafunu no akyi. Ɛma enzyme ahorow a ɛboa yɛn ma yɛyam aduan a yedi, ne hormone bi a wɔfrɛ no insulin a ɛhwɛ asikre dodow a ɛwɔ yɛn mogya mu so.

Enti, sɛ insulinoma yi ba a, ɛma insulin pii fi yɛn mogya mu sen sɛnea ɛsɛ sɛ ɛba. Ɛte sɛ nsu tap a asiw a ɛkɔ so tu.

Saa insulinomas yi yɛ ntini mu akisikuru bi a ɛba dwensɔtwaa mu a wɔfrɛ no Pancreatic Neuroendocrine Tumors (pNETs). Eyinom yɛ akisikuru a wɔntaa nhu koraa. Ɔfã a eye sen biara ne sɛ saa insulinomas yi mu 85% kosi 90% nyɛ nea ɛkɔ mmeae afoforo/ɛnyɛ adwuma. Eyi kyerɛ sɛ wɔntrɛw nkɔ nipadua no afã afoforo a ɛwɔ dwensɔtwaa no akyi. Nanso, ɛntaa nsi koraa sɛ wobetumi abɛyɛ metastatic/aggressive. Sɛ wɔyɛ saa a, ɛda adi kɛse sɛ wɔbɛtrɛw akɔ ntini a ɛbɛn hɔ ne mmerɛbo no mu.

Ɔkwan bɛn so na insulinoma ka nipadua no?

Madi kan aka sɛ insulinoma yɛ akisikuru a ɛma insulin dɔɔso dodo. Enti, dɛn na ɛba bere a insulin dɔɔso dodo no? Dwumadi titiriw a insulin yɛ ne sɛ ɛde asikre (yɛfrɛ no glucose nso) a ɛwɔ mogya no mu no kɔ nkwammoaa no mu. Afei nkwammoaa no nya ahoɔden. Nanso sɛ insulin dɔɔso dodo a, asikre dodow a ɛwɔ mogya no mu no so tew mpofirim. Yɛfrɛ tebea yi asikre a ɛba fam . Wɔ Sinhala kasa mu no, ɛkyerɛ sɛ asikre a ɛwɔ mogya mu no so tew.

Sɛ asikre a ɛwɔ wo mogya mu no so tew saa a, wufi ase hu sɛnkyerɛnne ahorow.

Fa no sɛ, woadi anɔpaduan, akɔ adwumayɛbea, na woreyɛ adwuma. Mpofirim ara, wote yaw, wo ho fifiri, wo ho yɛ wo yaw, na wo ti yɛ wo yaw. Ɛte sɛ nea woabrɛ na ɔkɔm de wo.

Wɔ mmere a ɛte sɛɛ mu no, sɛ wodi anaa wonom biribi a ɛyɛ dɛ te sɛ apɔw-mu-teɛteɛ bi, tii kuruwa a asikre wom, anaa banana a, wubefi ase ate nka wɔ bere bi akyi.

Nanso, asikre a ɛwɔ mogya mu a ɛba fam te sɛ eyi, titiriw a wunnim nea ɛde ba na wunnim bere a ɛbɛsan asi bio no yɛ hu ankasa. Enti, ɛyɛ adwene pa sɛ wode aduan ketewaa bi te sɛ toffee bɛbɛn hɔ bere nyinaa. Afei nso, sɛ woanya saa osuahu yi a, ɛsɛ sɛ wokɔ oduruyɛfo nkyɛn ntɛm ara na woka ho asɛm kyerɛ wɔn.

Dɛn ne eyi ho sɛnkyerɛnne?

Insulinooma ho sɛnkyerɛnne titiriw ne sɛnea yɛadi kan aka no, asikre a ɛba mogya mu (hypoglycemia). Eyi betumi de yare no ho sɛnkyerɛnne ahorow aba.

Nsɛnkyerɛnne a ɛtaa ba:

Eyinom ne sɛnkyerɛnne ahorow a edi kan a ebia wubehu:

• Adwene a ɛyɛ basaa anaa ɛyɛ den sɛ wode w’adwene besi biribi so: Te sɛ nea wo ti twitwa, wuntumi mfa w’adwene nsi nea woreyɛ no so.
• Fifiri: Fifiri kɛkɛ, ebia fifiri a ɛyɛ nwini.
• Koma a ɛbɔ: Wote nka sɛ wubetumi ate wo koma a ɛrebɔ.
• Dadwen anaa abufuw: Ehu tebea bi kɛkɛ, a ɛnyɛ den sɛ obi bo fuw.
• Wosow: Ɛte sɛ nea wo akwaa rewosow.
• Ɔkɔm kɛse a wɔte nka.

Nsɛnkyerɛnne a emu yɛ den:

Sɛ asikre dodow a ɛwɔ wo mogya mu no so tew dodo a, tebea no betumi ayɛ nea emu yɛ den kɛse. Ebia wubenya yare no ho sɛnkyerɛnne te sɛ:

• Anisoadehu sesa: Anisoadehu yɛ nea ɛyɛ kusuu, te sɛ nea wuhu nneɛma abien prɛko pɛ.
• Ɔkasa mu nsɛnnennen: nsɛmfua a wɔde di dwuma ɔkwammɔne so, wontumi nkasa pefee.
• Kari pɛ anaa nhyehyɛe a wɔhwere: Sɛ worehinhim bere a wonam no, wowosow wo ho kɔ anim ne akyi bere a wode ne nsa rekɔ biribi so no.
• Akisikuru: Ebetumi aba te sɛ nea akisikuru.
• Nhumu a wobɛyera: Ebia wobɛtotɔ piti na woahwe ase.

Mpɛn pii no, nnipa a wɔwɔ insulinoma no nya asikre a ɛba fam yi wɔ mogya mu anɔpa, kyerɛ sɛ, bere a wɔanyan bere a wɔadi mmuada nnɔnhwerew kakraa bi akyi bere a wɔadi anwummere aduan awie no. Yɛfrɛ eyi ``mmuadadi mu asikre a ɛba fam''. Nanso, nnipa binom tumi nya saa asikre a ɛba fam yi wɔ mogya mu bere a wɔadidi akyi bere tiaa bi mpo.

Eyi ho hia yiye: Asikre dodow a ɛkɔ fam wɔ mogya mu no betumi asiw wo da biara da dwumadi ahorow kwan, na ɛtɔ mmere bi a ebetumi ama w’amemene asɛe, woakɔda, na woawu mpo. Enti, sɛ wowɔ sɛnkyerɛnne ahorow a ɛkyerɛ sɛ asikre a ɛwɔ wo mogya mu no so atew a, hwɛ hu sɛ wobɛkɔ oduruyɛfo nkyɛn.

Dɛn nti na insulinoma yi ba?

Nokwarem no, nhwehwɛmufo nnya nhuu nea enti a nkwammoaa a ɛma insulin wɔ dwensɔtwaa no mu no mu paapae mpofirim na ɛdɔɔso a wontumi nni so, na ɛyɛ saa akisikuru yi ankasa.

Nanso ade biako na wɔahu. Ɛne sɛ, ɛtɔ mmere bi a wɔfrɛ tebea a wɔfrɛ no insulinoma yi Multiple Endocrine Neoplasia type 1, anaa (MEN1).Ebetumi ne awosu mu tebea bi a wɔfrɛ no insulinoma nso abata ho. Eyi ne bere a akisikuru ba yɛn nipadua mu ntini a ɛma hormone no pii mu (sɛ nhwɛso no, pituitary gland, parathyroid gland, pancreas). Ɛnyɛ insulinoma nyinaa na MEN1 na ɛde ba, nanso insulinoma nyinaa mu 5% kosi 10% na MEN1 na ɛde ba.

Sɛ nnuruyɛfo aka akyerɛ w’abusua mufo te sɛ wo maame, wo papa, anaa wo nuanom sɛ wɔwɔ yare no (MEN1) a, ɛsɛ sɛ wo ne wo duruyɛfo kasa fa awosu mu nhwehwɛmu ho . Eyi betumi aboa wo ma woahu sɛ wowɔ yare no anaa. Sɛ wowɔ (MEN1) a, nhwehwɛmu ahorow yi nso betumi aboa ma woahu saa akisikuru yi ansa na ayɛ kɛse.

Ɔkwan bɛn so na nnuruyɛfo hu eyi?

Sɛ wokɔ oduruyɛfo nkyɛn a, wobebisa wo wo yare no ho sɛnkyerɛnne na wɔahwɛ wo. Nsɛnkyerɛnne atitiriw abiɛsa na ɛkyerɛ sɛ wowɔ insulinoma. Yɛfrɛ eyinom Whipple baasakoro .

Wɔne:

1. Sɛ wowɔ asikre a ɛba mogya mu ho sɛnkyerɛnne (te sɛ adwenemhaw ne fifiri, sɛnea yɛadi kan aka no) .

2. Nhwehwɛmu a ɛkyerɛ sɛ asikre dodow a ɛwɔ mogya mu no sua. (Mpɛn pii no, nsateaa mu nhwehwɛmu kyerɛ sɛ asikre dodow a ɛwɔ mogya mu no nnu 55 mg/dL)

3. Sɛ wudi anaa wonom biribi a asikre (carbohydrates) wom a, yare no ho sɛnkyerɛnne tu mpɔn.

Sɛ wowɔ saa sɛnkyerɛnne abiɛsa yi nyinaa a, ebia wo duruyɛfo besusuw sɛ wowɔ insulinoma. Afei ɔbɛhyɛ sɛ wɔnyɛ nhwehwɛmu kakraa bi bio mfa nkyerɛ sɛ wɔahu yare no.

Nnɔnhwerew 72 sɔhwɛ a wɔde yɛ ntɛmntɛm

Eyi ne nhwehwɛmu titiriw, "sika kɔkɔɔ-gyinabea" a wɔde hwehwɛ insulinoma. Ɛhwehwɛ sɛ wudi mmuada bɛyɛ nnɔnhwerew 72. Nanso mma ɛnhaw wo, wɔyɛ eyi wɔ ayaresabea, wɔ oduruyɛfo anaa ɔyarehwɛfo hwɛ ase. Ɛnyɛ wo nko ara.

Sɛ wudi mmuada saa a, asikre dodow a ɛwɔ wo mogya mu no so tew na wufi ase nya sɛnkyerɛnne ahorow a, nnuruyɛfo begye mogya afi wo hɔ na wɔayɛ nea edidi so yi mu nhwehwɛmu:

• Asikre dodow a ɛwɔ mogya mu
• Insulin dodow a ɛwɔ nipadua no mu
• Proinsulin dodow a ɛwɔ nipadua no mu
• C-peptide dodow a ɛwɔ nipadua no mu
• Beta-hydroxybutyrate dodow a ɛwɔ nipadua no mu
• Sulfonylurea dodow (wɔde eyi hwɛ sɛ nnuru bi a wɔde sa asikreyare wɔ mogya no mu anaa) .

Sɛ wonom mogya no wie a, nnuruyɛfo bɛsa wo mogya mu asikre a ɛba fam no yare. Nea efi nhwehwɛmu ahorow yi mu ba no betumi aboa ma woahu sɛ ebia asikre a ɛba wo mogya mu no fi insulin pii (yɛfrɛ eyi hyperinsulinemia).

Sɔhwɛ afoforo bɛn na wɔyɛ? (Mfonini ho sɔhwɛ ahorow) .

Sɛ nnɔnhwerew 72 mmuadadi nhwehwɛmu no kyerɛ sɛ obi anya insulinoma a, ade a edi hɔ ne sɛ wobehu baabi a akisikuru no wɔ wɔ dwensɔtwaa no mu ne sɛnea ne kɛse te. Ebia eyi bɛhwehwɛ sɛ wɔyɛ scan a edidi so yi mu biako anaa nea ɛboro saa:

• CT scan a wɔde yɛ adwuma
• MRI scan a wɔde yɛ nhwehwɛmu
• Yafunu mu ultrasound scan a wɔde yɛ nhwehwɛmu
• Endoscopic ultrasound (EUS): Wɔ eyi mu no, wɔde afiri bi a mfoninitwa afiri ketewaa bi wom fa ano no mu na ɛkɔ dwensɔtwaa no mu pɛɛ.

Sɛ saa mfonini ahorow yi ntumi nkyerɛ beae pɔtee a akisikuru no wɔ a, ebia wo duruyɛfo bɛkra sɛ wɔnyɛ nhwehwɛmu titiriw foforo a wɔfrɛ no selective arterial calcium stimulation test. Eyi yɛ sɔhwɛ a emu yɛ den kɛse.

Dɛn ne ayaresa a wɔde sa eyi?

Asɛmpa no ne sɛ wobetumi de oprehyɛn asa insulinoma dodow no ara koraa, titiriw sɛ akisikuru no ntrɛw nkɔ mmeae afoforo (a ɛnyɛ nea ɛtrɛw) a.

Ade titiriw ne oprehyɛn no.

Oprehyɛn ahorow pii wɔ hɔ. Wo duruyɛfo begyina wo akisikuru no su, beae, ne ne kɛse so asi oprehyɛn a ɛfata wo ho gyinae.

• Enucleation: Nea ɛka eyi ho ne sɛ wobeyi akisikuru no nkutoo afi hɔ a wɔrensɛe dwensɔtwaa no kɛse, te sɛ nea wɔde ahwɛyiye yi nkesua a wɔanoa mu akisikuru nkutoo fi mu no.
• Pancreatectomy fã bi: Sɛnea edin no kyerɛ no, eyi hwehwɛ sɛ wotwitwa dwensɔtwaa no fã bi na woyi fi hɔ wɔ baabi a akisikuru no wɔ.
• Whipple oprehyɛn: Eyi yɛ oprehyɛn kɛse. Wɔyɛ no bere a akisikuru no atrɛw (metastatic). Nea ɛka ho ne sɛ wobeyi dwensɔtwaa no fã bi ne ntini bi a ɛbɛn hɔ.

Oprehyɛn biara wɔ asiane ahorow bi. Wo duruyɛfo bɛkyerɛkyerɛ ne nyinaa mu akyerɛ wo.

Ɔkwan bɛn so na wobedi asikre a ɛba fam wɔ mogya mu no so ansa na wɔayɛ oprehyɛn ne sɛ oprehyɛn ntumi nyɛ yiye a?

Enkosi sɛ wɔbɛyɛ oprehyɛn, anaasɛ sɛ oprehyɛn ntumi nyɛ yiye esiane biribi nti a, ɛho hia yiye sɛ wohwɛ asikre dodow a ɛwɔ wo mogya mu no so.

• Hwɛ asikre dodow a ɛwɔ wo mogya mu daa: Ebia wo duruyɛfo bɛkamfo akyerɛ sɛ fa Continuous Glucose Monitoring (CGM) nhyehyɛe di dwuma . Eyi betumi aboa wo ma woahwɛ asikre dodow a ɛwɔ wo mogya mu bere nyinaa. Eyi betumi aboa wo ma woahu asikre dodow a ɛba fam wɔ wo mogya mu ntɛm, titiriw anadwo.

Nanso kae sɛ, wɔmfa saa `(CGM)` yi nhu tebea horow te sɛ insulinoma, na mmom wɔde hwɛ yare no bere a wɔagye atom pɛn no.

• Nsakrae a ɛba aduan mu: Nnuan a wodi daa, titiriw carbohydrates a ɛyɛ den (sɛ nhwɛso no, paanoo a wɔde aburow ayɛ, aburow a ɛyɛ bruu, nhabannuru) betumi aboa ma asikre a ɛwɔ mogya mu a ɛbɛkɔ fam mpofirim no ano. Sɛ wodi aduan ketewaa bi ansa na woada a, ebetumi aboa nnipa binom nso.
• Glucose a wɔde fa ntini mu (IV glucose): Sɛ asikre a ɛwɔ wo mogya mu no so tew kɛse a, wobetumi afa nkyene so ama wo glucose wɔ ayaresabea.
• Nnuru ahorow a wɔde di dwuma:
• Diazoxide: Saa aduru yi tumi siw insulin a efi dwensɔtwaa mu no ano. Ebetumi nso ama glucagon (a ɛma asikre dodow a ɛwɔ mogya mu no kɔ soro) a efi mmerɛbo no mu no ayɛ kɛse.
• Octreotide ne Lanreotide: Saa nnuru yi nso boa ma insulin a efi insulinoma ahorow bi mu no so tew.

Ɛho hia yiye sɛ wode aduruyɛ krataa a ɛkyerɛ sɛ asikre a ɛwɔ wo mogya mu no sua bɛkɔ bere nyinaa. Saa kwan no so no, sɛ wohyia ɔhaw mpofirim a, obi betumi aboa wo ntɛm. Afei nso, ma w’abusuafo ne wo nnamfo nhu eyi ne sɛnea wobetumi aboa.

Sɛ akisikuru no atrɛw (metastatic) a, dɛn na ɛsɛ sɛ wɔyɛ?

Ɛntaa mma koraa sɛ, sɛ insulinoma no atrɛw akɔ nipadua no afã afoforo (metastatic) a, nnuruyɛfo betumi de oprehyɛn ne ayaresa afoforo aka ho. Anaasɛ, sɛ oprehyɛn ntumi nyɛ yiye a, wobetumi de saa aduruyɛ yi adi dwuma.

• Peptide Receptor Radionuclide Ayaresa (PRRT) a Wɔde Ma .
• Ayaresa a wɔde wɔn ani asi so
• Nnuru a wɔde sa yare

Eyinom yɛ ayaresa a ɛyɛ den kakra, a wo duruyɛfo bɛkyerɛkyerɛ mu akyerɛ wo.

So wobetumi asa eyi?

Aane! Mpɛn pii no, wobetumi asa insulinoma koraa denam oprehyɛn so. Nhwehwɛmu bi kyerɛe sɛ nnipa a wɔyɛɛ wɔn oprehyɛn wɔ insulinoma a ɛnyɛ nea ɛkɔ mmeae afoforo ho no mu 87% da so te ase wɔ mfe 10 akyi wɔ bere a wohuu sɛ wɔwɔ bi no. Ɛno yɛ rate a eye ankasa.

Nanso, sɛ akisikuru no atrɛw (metastatic) a, wɔka sɛ mfe 10 a wɔde tra ase no bɛyɛ 33%. Nanso kae sɛ eyinom yɛ akontaabu a ɛfa nneɛma nyinaa ho ara kwa. Ɛdenam wo tebea so no, w’aduruyɛfo kuw no betumi ama wo nsɛm a ɛyɛ nokware kɛse.

Ɛyɛ nokware sɛ asɛmfua "tumor" betumi abɔ yɛn hu. Titiriw bere a ɛyɛ tebea a ɛntaa nsi te sɛ insulinoma no. Nanso nea eye sen biara ne sɛ wobetumi de oprehyɛn ayɛ eyinom mu dodow no ara. Ɛno mpo no, ɛnyɛ mmerɛw sɛ wubehu sɛ wowɔ yare bi a ɛntaa nsi a ɛsɛ sɛ wɔyɛ oprehyɛn. Nanso ɛnyɛ wo nkutoo na wowɔ. W’aduruyɛfo kuw no bɛba hɔ ama wo bere nyinaa, abua wo nsɛmmisa, na wɔaboa wo. Sɛ wote nka sɛ woayɛ basaa wɔ nkate fam a, wo ne wo duruyɛfo nkasa mfa ɛno nso ho na hwehwɛ nnwuma ahorow a wubetumi anya mmoa afi mu no ho asɛm.

Nneɛma a ɛho hia paa sɛ wobɛkae (Take-Home Message) .

Okay, enti, eyinom ne nneɛma a ɛho hia sen biara a ɛsɛ sɛ wokae fi nea yɛaka ho asɛm nnɛ no mu:

• Insulinoma yɛ akisikuru a ɛnyɛ hu (a ne fã kɛse no ara nyɛ hu) a ɛba dwensɔtwaa mu. Ɛma insulin pii ba.
• Eyi betumi ama asikre a ɛwɔ mogya mu no so atew mpofirim (hypoglycemia). Eyi betumi ama wɔanya yare no ho sɛnkyerɛnne te sɛ adwenemhaw, fifiri, ne koma a ɛbɔ.
• Sɛ wotaa hu saa sɛnkyerɛnne ahorow yi a, hwɛ hu sɛ wobɛkɔ oduruyɛfo nkyɛn.
• Wobetumi afa sɔhwɛ titiriw bi so ahu eyi ( nnɔnhwerew 72 mmuadadi sɔhwɛ, scan).
• Ayaresa titiriw ne oprehyɛn. Mpɛn pii no, eyi ma wonya ayaresa koraa.
• Ansa na wobɛyɛ oprehyɛn, anaasɛ sɛ oprehyɛn ntumi nyɛ yiye a, wubetumi afa aduan ne nnuru so ahyɛ asikre a ɛba fam wɔ mogya mu no so.
• Ɛwom sɛ eyi yɛ tebea a ɛntaa nsi de, nanso sɛ wohu ntɛm na wɔsa no yiye a, wobetumi anya nneɛma pa.

Mma ɛnhaw wo, te sɛ yare foforo biara no, aduru bi wɔ hɔ a wɔde sa eyi. Ade a ɛho hia sen biara ne sɛ wobɛhwɛ yare no ho sɛnkyerɛnne no so na woahwehwɛ aduruyɛ mu afotu ntɛm ara sɛnea wubetumi.

` Insulinoma, dwensɔtwaa, insulin, asikre a ɛba fam wɔ mogya mu, asikre a ɛba fam, akisikuru, hormone, dwensɔtwaa mu kokoram