Endoscopic ultrasonography (EUS) in the localization of insulinoma

Sotoudehmanesh, Rasoul; Abbastabar, Hedayat; Shirazian, Nahid; Shahraeeni, Shadi; Ainechi, Sanaz; Zeinali, Fatemeh; Kolahdoozan, Shadi

doi:10.1007/s12020-007-0045-4

Cited by 133 publications

(78 citation statements)

References 17 publications

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“…In some centres, this is used as the primary pre-operative localizing modality. 17,18 We tend to use it in obese patients and in the follow-up of patients with a positive selective arterial calcium stimulation test, particularly when the data suggests a tumour arising within the head or uncinate of the pancreas. At the time of surgical exploration, the entire pancreas should be exposed and carefully palpated, with the aid of intraoperative ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

What should be done in an operating room when an insulinoma cannot be found?

Rostambeigi

Thompson

2009

Clinical Endocrinology

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SummaryInsulinoma is the most common (functioning) islet cell tumour of the pancreas and is highly curable with accurate localization and precise extirpation of the often benign, solitary lesion. Although previous reports describe high success rates without pre-operative localization, more recent recognition of the overlap among causes of endogenous hyperinsulinism, coupled with the deleterious long-term effects of blind distal pancreatectomy and re-operation, mandate the need for precise pre-operative localization or regionalization of the tumour(s). If these criteria have not been met and the surgeon finds him/herself in the operating room without a localized or regionalized tumour, the operation should be concluded without resection, the diagnosis reconfirmed, and a calcium stimulation test performed. At experienced centres, this can be often carried out within 24 -48 h and the patient returned to the operating room for a gradient-guided resection. Intraoperative venous sampling for insulin might be an option in the future but its accuracy has not been validated in sufficient numbers of patients to date. Insulinoma is the most common functioning endocrine tumour of the pancreas, seen in approximately four persons per 1 000 000 persons/year. More than 90% of insulinomas are benign, solitary, and < 2 cm in diameter. Importantly, insulinomas are equally distributed throughout the gland. The female : male ratio is approximately 3 : 2. Less than 10% are seen in association with the multiple endocrine neoplasia type 1 (MEN1) syndrome, and 5-10% of tumours are malignant.1,2 Mean age at presentation is approximately 45 years.Multiple insulinomas can be seen in 2-3% of sporadic cases but are more often seen in the MEN1 syndrome; although the insulinsecreting tumour itself is very often solitary.3,4The diagnosis of insulinoma can be challenging. 5,6 Although originally considered to present only in the fasting state or with exercise, it is now known that patients with an insulinoma can present with postprandial symptoms as well. Patients may have nonspecific adrenergic symptoms, which include anxiety, sweating and palpitations, but true organic endogenous hyperinsulinism is characterized by neuroglycopaenic symptoms that include confusion, amnesia, visual disturbances, seizures and coma. The diagnosis of endogenous hyperinsulinism is dependent on the satisfaction of Whipple's triad and remains the cornerstone of the screening process: hypoglycaemia (plasma glucose < 50 mg/dl), neuroglycopaenic symptoms, and prompt relief of symptoms with the administration of glucose define Whipple's triad. 2 Once Whipple's triad has been satisfied, the patient should be fasted either formally (72-h fast) or informally (outpatient) to a plasma glucose < 50 mg/dl with concomitant documentation of inappropriate β -cell polypeptides (insulin, C-peptide, and proinsulin). With a glucose level ≤ 45 mg/dl, an insulin level ≥ 3 μ IU/ml and a C-peptide level of ≥ 200 pmol/l, the endogenous nature of the hyperinsulinism is confirmed. It is impor...

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Section: Discussionmentioning

confidence: 99%

What should be done in an operating room when an insulinoma cannot be found?

Rostambeigi

Thompson

2009

Clinical Endocrinology

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“…EUS localizes up to 93% of PETs (44), and 87% of insulinomas (45) with a sensitivity of 89.5% (46). EUS-FNAP reaches a diagnosis in 90-100% of cases (47)(48)(49) (Fig.…”

Section: Discussionmentioning

confidence: 98%

Pancreatic endocrine tumors or apudomas

Varas¹,

Gornals²,

Ponseti³

et al. 2011

Rev. esp. enferm. dig.

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“…Genellikle 1-2 cm çapında iken 15 cm'ye kadar ulaşabilir (9). İnsülinomalar hem BT'de hemde MR'de karakteristik görünümleri olmasına rağmen sensitiviteleri daha düşüktür, sırasıyla %33-%64 ve %40-%90 (10,11). İki cm üstündeki tümörlerde görüntüleme yöntemlerinin sensitivitesi daha yüksektir.…”

Section: Discussionunclassified

A Case Report of Insulinoma Located with Calcium Stimulation Test

Tuna¹,

Doğan²,

Arduç³

et al. 2014

Haseki

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ÖzetNadir görülmesine rağmen insülinomalar pankreatik nöroendokrin tümörlerin en sık görülen formudur. Hipoglisemiye bağlı olarak yaşamı tehdit edici olabilmektedir. Tanı klinik ve laboratuvar bulguları ile konur. Radyolojik görüntüleme ayırıcı tanıda ve operasyon prosedürünü belirlemede yardımcıdır. Taramalarda tümör görüntülenemediyse selektif arteryel kalsiyum stimulasyon testi ile tanı ve lokalizayon sağlanabilir. Burada sadece kalsiyum stimulasyon testi ile lokalize edilebilen ve başarılı şekilde opere edilen insülinomalı olguyu sunduk. (Ha se ki T›p Bül te ni 2014; 52: 296-8) Anahtar Sözcükler: Hipoglisemi, insülinoma, kalsiyum stimulasyon testi Abs tractAlthough rarely seen, insulinomas are the most common neuroendocrine tumors of the pancreas. It can be life threatening due to hypoglisemia. Diagnosis is base on clinical and laboratory findings. Radiological findings are helpful to confirm the diagnosis and to determine surgical procedure. If no tumor found by radiological investigations, selective arterial calcium stimulation test can be performed for the diagnosis and localization. Here, we report a case of insulinoma which truly located only with the calsium stimulation test, and operated successfully. (The Me di cal Bul le tin of Ha se ki 2014; 52: 296-8)

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Endoscopic ultrasonography (EUS) in the localization of insulinoma

Abstract: EUS is an accurate method for detection of insulinoma. The accuracy depends on the location of the tumor and is greatest for tumors in the pancreatic head.

Cited by 133 publications

References 17 publications

What should be done in an operating room when an insulinoma cannot be found?

What should be done in an operating room when an insulinoma cannot be found?

Pancreatic endocrine tumors or apudomas

A Case Report of Insulinoma Located with Calcium Stimulation Test

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