RF05 | PSUN376 Incidence of Diabetes Mellitus Following Pancreatic Surgery in Individuals with Multiple Endocrine Neoplasia Type 1

Abstract

Abstract Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant hereditary disorder characterized by hyperparathyroidism, pituitary adenomas, and well-differentiated neuroendocrine tumors of the foregut. Pancreatoduodenal neuroendocrine tumors are often managed via surgical intervention, which increases the risk for new onset, post-operative diabetes mellitus (DM). Current estimates of post-operative DM in MEN1 range between 10-86%. Here, we present a retrospective review of the incidence of DM following pancreatic surgery in individuals with MEN1at a single tertiary care center between 2005-2021. Patients with a clinical or molecular diagnosis of MEN1 with and without pancreatic surgery were identified via the electronic medical record system. A retrospective chart review collected baseline demographic and clinical data. Individuals with an insulinoma diagnosis were excluded. A diagnosis of DM was defined as a hemoglobin A1c greater than 6.5%, fasting plasma glucose level greater than 126 mg/dl, or a random plasma glucose greater than 200 mg/dl. One-hundred and eighteens adult patients (66F, 52M) with MEN1 were identified. Radiographic evidence of a pancreatic tumor was demonstrated in 84 (71.2%) patients, of which 49 (41.5%) underwent surgical resection (40 (81.6%) distal pancreatectomy with or without enucleation, 6 (12.2%) Whipple procedure, 2 (4.1%) enucleation, and 1 (2.0%) total pancreatectomy) of a pancreatic neuroendocrine tumor (pNET). All but one individual were included in the post-surgical study cohort as it was unknown if onset of DM preceded operation. Fourteen (28.5%) underwent another subsequent pancreatic surgery. Of the above 48 surgical patients, 3 (6.1%) had a pre-operative diagnosis of diabetes. Within the remaining 45 patients, 31 (68.9%) developed a diagnosis of DM following surgery (mean post-operative onset 4.2 years [range 0.1–16.3]). Of the 69 individuals who did not undergo surgery but did have a diagnosis of MEN1, just 15 (21.7%) developed DM and at an older average age 53.4 [range 14–70] when compared to their surgical cohorts 47.5 [range 27–75]. With 61.2% of patients with resected pNET developing DM compared to their non-operative counterparts (21.7%) (p = 0.25), there is a strong suggestion of morbidity associated with pancreatic surgery secondary to the development of DM. Endocrinologists and surgical teams should be aware of the associated risks and screen accordingly with yearly hemoglobin A1c compared to the standard three-year interval begun at age 45 as suggested by the American Diabetes Association. Additionally, patients should be appropriately educated on the signs/symptoms of DM. Presentation: Saturday, June 11, 2022 1:30 p.m. - 1:35 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.