Evaluation of preoperative and intraoperative arterial stimulation and venous sampling for diagnosis and surgical resection of insulinoma

Aoki, Taro; Sakon, Masato; Ohzato, Hiroki; Kishimoto, S; Oshima, Satoshi; Yamada, Terumasa; Higaki, Naozumi; Nakamori, Shoji; Gotoh, Mitsukazu; Ishikawa, Osamu; Ohigashi, Hajime; Imaoka, Shingi; Hasuike, Yasunori; Shibata, Kunitaka; Monden, Morito

doi:10.1016/s0039-6060(99)70040-1

Cited by 28 publications

(11 citation statements)

References 26 publications

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“…The intra-arterial calcium injection (Imamura) test may regionalize the hypersecretion and thereby make preoperative decision easier. 39,40 In one of our patients, this test regionalized the lesions to the pancreatic body tail.…”

Section: Discussionmentioning

confidence: 73%

Laparoscopic Surgery in Patients With Sporadic and Multiple Insulinomas Associated With Multiple Endocrine Neoplasia Type 1

Fernández‐Cruz¹,

Martínez²,

Cesar‐Borges³

et al. 2005

Journal of Gastrointestinal Surgery

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Section: Discussionmentioning

confidence: 73%

Laparoscopic Surgery in Patients With Sporadic and Multiple Insulinomas Associated With Multiple Endocrine Neoplasia Type 1

Fernández‐Cruz¹,

Martínez²,

Cesar‐Borges³

et al. 2005

Journal of Gastrointestinal Surgery

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“…Intra-arterial calcium stimulation combined with hepatic venous sampling has been reported to achieve a success rate of up to 90% in the localisation of insulinomas. Results should be interpreted in combination with those from other imaging modalities 110 111…”

Section: Imagingmentioning

confidence: 99%

Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs)

Ramage

Ahmed

Ardill

et al. 2011

Gut

637

454

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These guidelines update previous guidance published in 2005. They have been revised by a group who are members of the UK and Ireland Neuroendocrine Tumour Society with endorsement from the clinical committees of the British Society of Gastroenterology, the Society for Endocrinology, the Association of Surgeons of Great Britain and Ireland (and its Surgical Specialty Associations), the British Society of Gastrointestinal and Abdominal Radiology and others. The authorship represents leaders of the various groups in the UK and Ireland Neuroendocrine Tumour Society, but a large amount of work has been carried out by other specialists, many of whom attended a guidelines conference in May 2009. We have attempted to represent this work in the acknowledgements section. Over the past few years, there have been advances in the management of neuroendocrine tumours, which have included clearer characterisation, more specific and therapeutically relevant diagnosis, and improved treatments. However, there remain few randomised trials in the field and the disease is uncommon, hence all evidence must be considered weak in comparison with other more common cancers.

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“…O uso da ultra-sonografia intra-operatória também é pouco acurado 14 . A dosagem de insulina, após o cateterismo seletivo de veias pancreáticas e o estímulo arterial com cálcio para liberação do hormônio, parece ser um método fidedigno para a localização de tumor residual na sala cirúrgica 7, 15 . O caso apresentado foi representativo da necessidade de reintervenção a despeito da confirmação histopatológica do insulinoma.…”

Section: Relato Do Casounclassified

Anestesia para paciente portadora de múltiplas afecções endócrinas: relato de caso

Maciel¹,

Fernandes²,

Pereira³

2008

Rev. Bras. Anestesiol.

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BACKGROUND AND OBJECTIVES:Insulinoma is the most common pancreatic endocrine tumor and it can be associated with multiple endocrine neoplasia (MEN). This is a report on a patient with multiple endocrine abnormalities, who did not fulfill the criteria of known syndromes (MEN) and the clinical-anesthetic particularities that influenced the anesthetic management. CASE REPORT:A 23-year old female patient with episodes of hypoglycemia difficult to control, associated with Cushing's disease and prolactinoma without symptoms of pituitary compression and with normal thyroid and parathyroid. Investigation found a retroperitoneal mass of unknown origin which in face of the clinical presentation raised the hypothesis of insulinoma. The patient also referred to be a Jehovah's Witness. Biopsy of the mass by videolaparoscopy and enucleation of the insulinoma were proposed. On physical exam the patient was overweight, had protruding teeth, she was classified as Mallampati 3 and had symptoms of sleep apnea. Laboratorial exams revealed hematocrit 58%. Pre-anesthetic medication consisted of oral midazolam (7.5 mg) and clonidine (200 µg). Fentanyl (150 µg), clonidine (90 µg), propofol (150 mg) and pancuronium (8 mg) were used for anesthetic induction and she was intubated without intercurrences. Central venous access and invasive blood monitoring were instituted. Intravenous infusion of D5W with electrolytes was instituted and capillary glucose levels were monitored every 30 minutes, which did not demonstrate any episodes of hypoglycemia during the surgery. The patient remained hemodynamically stable even during the pneumoperitoneum. She developed postoperative episodes of hypoglycemia, which motivated the re-operation. CONCLUSIONS:This case is unique due to the presence of multiple endocrine abnormalities and the particularities of the surgicalanesthetic management. Intraoperative monitoring is mandatory during removal of an insulinoma to avoid incomplete tumor resection. Multiple challenges in one patient demand the knowledge, by the anesthesiologist, of each obstacle and its interactions in order to devise strategies to control them.

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Evaluation of preoperative and intraoperative arterial stimulation and venous sampling for diagnosis and surgical resection of insulinoma

Cited by 28 publications

References 26 publications

Laparoscopic Surgery in Patients With Sporadic and Multiple Insulinomas Associated With Multiple Endocrine Neoplasia Type 1

Laparoscopic Surgery in Patients With Sporadic and Multiple Insulinomas Associated With Multiple Endocrine Neoplasia Type 1

Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs)

Anestesia para paciente portadora de múltiplas afecções endócrinas: relato de caso

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