Insulinoma: Selective arterial calcium injection performed to confirm localization and complete resection

Yano, Seiji; Sumi, Shoichiro; Nio, Yoshinori; Ooishi, Tatsuro; Yasunari, Kenichi; Minari, Yoshimitsu; Tamura, Katsuhiro

doi:10.1007/bf02489035

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…The noninvasive modalities of ultrasound, CT, and MRIoften fail to demonstrate insulinomas smaller than 15 mmin diameter (6). SACI was developed by Imamura et al and Doppmanet al in 1990 (2,6) and is now considered a primary diagnostic tool for assessing the location and function of insulinoma, replacing the use of percutaneous transhepatic portal venous sampling (PTVS) (7)(8)(9)(10)(11)(12). Compared with PTVS, SACI is less invasive and more sensitive (96.6% versus 87.1%).…”

Section: Discussionmentioning

confidence: 99%

An Insulinoma for which Secretin Test and Selective Arterial Calcium Injection Test were Useful.

Tanaka¹,

Hosoi²,

Yamamoto³

et al. 2002

Intern. Med.

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A 76-year-old womansuffered from somnolence while fasting for almost 2 years. Fasting plasma glucose (FPG) (40 mg/dl) and the immunoreactive insulin (IRI) level (8.8(lU/ml) were not compatible with Fajan's ratio or Turner's ratio observed in typical insulinoma. The secretin test showed no response to insulin secretion, suggesting the presence of insulinoma. Abdominal dynamic computed tomography (CT) revealed a 12-mm hypervascular lesion in the head of the pancreas. A selective arterial calcium infusion test (SACI) was performed, during which IRI in the hepatic venous blood was measured following selective intraarterial calcium infusion. An increase in IRI levels in the gastroduodenal and superior mesenteric arteries suggested the presence of a functional insulinoma in the head of the pancreas. Enucleation of the tumor improved FPGand IRI levels to 138 mg/dl and 3.8 jaU/ml, respectively. After surgery, a secretin test showed a 5-fold increase in IRI levels, suggesting normal (3 cell function. This case illustrates the value of the secretin test for the diagnosis of insulinoma and for the postoperative assessment of (3 cell function. It further illustrates the value of the SACI for localizing an insulinoma. (Internal Medicine 41: 839-841, 2002)

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Section: Discussionmentioning

confidence: 99%

An Insulinoma for which Secretin Test and Selective Arterial Calcium Injection Test were Useful.

Tanaka¹,

Hosoi²,

Yamamoto³

et al. 2002

Intern. Med.

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“…In addition, we also monitored the blood glucose level 16 to confirm the complete removal of tumors intraoperatively. Recently, intraoperative quick IRI radioimmunoassay 17 and the SACI test 18 have been reported to be highly sensitive for confirming tumor excision. In our second patient, IOBGM also proved helpful for confirming complete resection of the tumors.…”

Section: Discussionmentioning

confidence: 99%

Combining the selective arterial calcium injection test and intraoperative blood glucose monitoring for multiple insulinomas: Report of two cases

et al. 2000

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To date, no precise methods of preoperatively localizing multiple insulinomas or intraoperatively confirming their complete removal have been established. We describe herein the effectiveness of combining the selective arterial calcium injection (SACI) test to locate tumors preoperatively, with intraoperative continuous blood glucose monitoring (IOBGM) to confirm their complete removal. During the 8-year period from 1990 to 1997, we experienced two patients with multiple insulinomas. The first patient required resection of a residual tumor in the remnant pancreas for persistent hyperinsulinemia after a distal pancreatectomy performed under conventional diagnostic procedures. In the second patient, a SACI test was performed in addition to other diagnostic imaging procedures, and while computed tomography scan, endoscopic ultrasonography, and arteriography demonstrated multiple tumors in the body and tail of pancreas, the SACI test suggested that there were also tumors in the head of pancreas. Intraoperative ultrasonography showed a tumor measuring 5 mm in diameter on the surface of the head of the pancreas, apart from the multiple tumors in the body and tail of the pancreas. Complete removal of all tumors was assessed by the hyperglycemic rebound after resection of the tumors, determined by IOBGM. Based upon our experience, we believe that the SACI test and IOBGM are helpful for establishing precise localization and achieving complete removal of multiple insulinomas.

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Insulinoma: Selective arterial calcium injection performed to confirm localization and complete resection

Cited by 2 publications

References 16 publications

An Insulinoma for which Secretin Test and Selective Arterial Calcium Injection Test were Useful.

An Insulinoma for which Secretin Test and Selective Arterial Calcium Injection Test were Useful.

Combining the selective arterial calcium injection test and intraoperative blood glucose monitoring for multiple insulinomas: Report of two cases

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