Percutaneous transhepatic portal vein catheterization for localization of insulinoma

Tseng, Hsiao-Shan; Yao, Chao-Yuan; Zhong, Shouxian; Zhang, J X; Zhu, Yu

doi:10.1007/bf01654940

Cited by 14 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…b Estimated from the literature [12,22,23]. cephalic insulinoma, remained hypoglycemic and hyperinsulinemic after a blind left pancreatectomy and was cured by a secondary duodenopancreatectomy.…”

Section: Resultsmentioning

confidence: 99%

“…The physiologic values of serum insulin in portal blood are unknown. We estimated from the results of portal sampling and the insulin assay in patients without an insulinoma [12,22,23] that these values may be between 0 and 52 U/ml. Considering that more than 50% of insulin is withdrawn after the first hepatic passage and that the mean gradient between simultaneous portal and systemic serum insulin in our study was 2.3 Ϯ 0.4, these estimated portal figures seem in accordance with the normal range of systemic serum insulin (Ͻ 20 U/ml).…”

Section: Discussionmentioning

confidence: 99%

“…The physiologic characteristics of serum insulin in humans are summarized in Table 1. Normal serum insulin values in the portal blood were estimated as the mean Ϯ 2 standard deviations of the values obtained in 11 patients without insulinoma reported in the literature, including two patients with gastrinoma [22], two patients with glucagonomas [23], and seven patients with no endocrine tumor of the pancreas [12,22].…”

Section: Biochemical Assaymentioning

confidence: 99%

See 2 more Smart Citations

Intraoperative Insulin Measurement during Surgical Management of Insulinomas

et al. 1998

View full text Add to dashboard Cite

Intraoperative hormonal measurements have been used successfully to guide the surgical treatment of various endocrine diseases. In this study, we report the results of intraoperative insulin measurement (IIM) in patients with organic hypoglycemia. IIMs were performed during 52 operations in 51 patients. Hyperinsulinism was secondary to a sporadic insulinoma (M = 40), a type I multiple endocrine neoplasia (MEN-I) (M = 8), an insulin-secreting carcinoma (M = 1), or pancreatic nesidioblastosis (M = 2). The insulin was measured with a radioimmunologic assay in blood samples simultaneously drawn from a peripheral vein and the portal vein at the beginning of the operation (T1) and 20 minutes after tumor removal (T2). Normoglycemia was achieved after surgery in 50 cases (96%). Systemic and portal insulin levels were normal at T1 in eight patients, precluding any further interpretation of the test. Completeness of surgery was confirmed by normalization of both systemic and portal insulin levels at T2 in 36 patients. In seven cases the systemic or portal insulin levels (or both) remained elevated at T2 despite a favorable outcome after surgery. Failure of the surgical procedure was predicted in two patients by the persistence of high levels of insulin at T2. In patients with initially elevated serum insulin levels, the positive predictive value and the specificity of intraoperative insulin measurement for completeness of surgery were both 100%. The sensitivity was 84%, the negative predictive value 22%, and the accuracy of the test 84%. We concluded that IIM is a simple, highly reliable tool for predicting the completeness of surgery in patients with organic hypoglycemia. IIM appears to be a valuable addendum to the surgical armamentarium against insulinoma especially for patients with atypical causes, such as MEN, insulin-secreting carcinoma, or pancreatic nesidioblastosis.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Biochemical Assaymentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative Insulin Measurement during Surgical Management of Insulinomas

et al. 1998

View full text Add to dashboard Cite

show abstract

“…Computed tomography (CT) is effective for the diagnosis of insulinoma in no more than 20-30% of patients [8,12]. Angio CT scan and selective angiography are diagnostic only in 60-70% of patients [7, 12-151. Better results can be obtained by transhepatic portal venous sampling (THPVS) along the pancreatic vein [16][17][18][19][20][21]. Nevertheless, this technique may not allow the evaluation of small hormone gradients as they are observed in microadenomatosis, nesidioblastosis, and/3-cell carcinomas [16].…”

mentioning

confidence: 99%

The ultrasonic detection of insulinomas during surgical exploration of the pancreas

et al. 1987

View full text Add to dashboard Cite

The sensitivity of preoperative imaging was evaluated for the localization of insulinomas in 2 series of 54 and 17 patients, respectively. In the first series, diagnosis was obtained with ultrasonography (US) in 14.8%, with computed tomographic (CT) scan in 60%, and with arteriography and/or angio CT scan in 75% of patients. In the second series, US, CT scan, and arteriography were performed preoperatively showing a sensitivity of 53% of one or more of the imaging techniques. The last 17 patients all underwent intraoperative pancreatosonography, and the insulinoma was localized in each. Considering the high reliability of intraoperative ultrasonography, and the high costs and low benefits of other current diagnostic techniques, a new management plan is suggested for patients with a definite laboratory diagnosis of insulinoma.

show abstract

“…Bio-chemical diagnostic criteria for insulinoma used were plasma concentrations of glucose <55 mg/dl, insulin of at least 3.0 μU/ml (18 pmol/L) and C-peptide of at least 0.6 ng/ml (0.2 nmol/L). [ 5 ] 72 h fasting test was done if they did not have spontaneous hypoglycemia. All the cases of insulinoma were screened for MEN syndrome after the diagnosis of insulinoma was confirmed.…”

Section: Aterials and M Ethodsmentioning

confidence: 99%

Insulinoma case series: Experience of a tertiary care center

Anakal

Kalra

Dharmalingam

et al. 2014

Indian J Endocr Metab

View full text Add to dashboard Cite

Background:Insulinomas are usually solitary; benign and encapsulated small lesions and majority of them measure <2 cm in diameter. They pose a challenge for pre-operative localization. Definitive treatment is surgical excision of the tumor. Intra-operative ultrasonography (IOUS), transhepatic portal venous sampling (THPVS) and positron emission tomography (PET) scan can be done for tumors not localized by conventional imaging modalities.Materials and Methods:A retrospective study of patients diagnosed with insulinoma during the period 2004-2012 (8 years) was done. Biochemical diagnostic criteria used were plasma concentrations of glucose <55 mg/dl with corresponding insulin level >3.0 μU/ml (18 pmol/L) and C-peptide of >0.6 ng/ml (0.2 nmol/L). The localization of the tumor was done by various modalities namely computed tomography (CT), magnetic resonance imaging (MRI), IOUS, PET and portal venous sampling. The initial localizing technique in most of these patients were CT or MRI imaging, or both and those who were not localized by the above modalities were subjected to PET CT or THPVS or intra-operative ultrasound depending on the initial imaging results and patient's consent. All the modalities were not used in the same patient, but the modalities were decided as per the imaging results, patient's consent and affordability for the procedure.Results:Ninteen cases of insulinoma aged between 10 and 66 years, with a median age of 47 years were included in the analysis. There were 10 males and nine females. Eighty-three percent of patients presented with pre-prandial hypoglycemia (n = 15). Different modalities were employed for pre-operative localization of these patients out of which 5 (26.31%) cases were localized with CT, 5 (26.31) cases with MRI, 5 (26.31%) with THPVS, 1 (5.26%) case with PET CT, 3 (15.78%) of them could not be localized out of which 2 (10.52%) were localized by IOUS and 1 (5.26%) case the lesion could not be localized. Among 19 cases, 12 underwent surgery out of which one patient underwent distal pancreatectomy as tumor was not localized; eight underwent laparoscopic enucleation; three of them required intra-operative exploration and seven of them were not operated, as they did not give consent for surgery. In all the cases, the size of the insulinoma ranged between 1 and 2 cm.Conclusion:We report our experience with 19 cases of insulinoma and analyze the role of pre- and intra-operative imaging modalities in the surgical management of insulinomas. Most of our cases were symptomatic, and the most common presentation was with pre-prandial hypoglycemia. THPVS, PET scan and intra-operative ultrasound added to diagnostic sensitivity in some cases not localized by CT or MRI.

show abstract

Percutaneous transhepatic portal vein catheterization for localization of insulinoma

Cited by 14 publications

References 10 publications

Intraoperative Insulin Measurement during Surgical Management of Insulinomas

Intraoperative Insulin Measurement during Surgical Management of Insulinomas

The ultrasonic detection of insulinomas during surgical exploration of the pancreas

Insulinoma case series: Experience of a tertiary care center

Contact Info

Product

Resources

About