The Radiologist's role in acute endocrine problems

Abstract

Ultrasound and computed tomography have had an enormous impact on the imaging procedures used in the detection of tumors of the parathyroids, pancreas, and adrenals. Ultrasound is now the examination of choice in localizing parathyroid adenomas in the neck prior to cervical exploration or after unsuccessful exploration. Its role as a screening test in patients without biochemical confirmation of hyperparathyroidism awaits further study. Computed tomography is useful in identifying mediastinal parathyroid adenomas in patients who have had unsuccessful neck explorations and islet-cell tumors of the pancreas if they are sufficiently large (greater than 2 cm). Angiography remains the most accurate method of localizing insulinomas prior to surgery. Computed tomography scanning has become the procedure of choice in localizing adrenal tumors and has sufficient sensitivity to be used as a screening test in patients without biochemical confirmation of an adrenal abnormality.

Ultrasonic localization and cytologic identification of parathyroid tumors

“…Hypercalcemia is generally reversed in 90-95% of these cases [15][16][17]. It has been questioned if this result could be improved by a preoperative location of enlarged glands [4,5]. The benefit of ultrasound with respect to surgical success rates has not been addressed in the present investigation since this has to be decided by studies of extensive patient materials.…”

“…Ultrasonic examination of the parathyroid glands has attracted considerable interest in recent years for its ability to locate enlarged parathyroid glands prior to surgical therapy [1][2][3][4][5][6]. The identity of ultrasonically detected tumors may be difficult to establish unequivocally from the echogram [6].…”

“…False-positive examinations mainly arise from the misinterpretation of lymph nodes and dorsally projecting thyroid nodules [1][2][3][4][5][6]. In order to obtain means for a cytologic discrimination, we have used a method for ultrasonically guided fine-needle biopsies.…”

The ultrasonic detection of insulinomas during surgical exploration of the pancreas

“…Fourteen percent of these tumors have sizes less than 1 cm and cannot be visualized preoperatively, despite good diagnostic procedures [8,11]. Ten percent of insulinomas are neither visible nor palpable on bimanual exploration of the pancreas [7,37,38]. These diagnostic difficulties are due to the cephalic site of the tumor and its deep location within the gland [19].…”

Clinical outcomes of 15 consecutive patients who underwent laparoscopic insulinoma resection: The usefulness of monitoring intraoperative blood insulin during laparoscopic pancreatectomy

“…There are three methods for determining tumor localization during surgery: inspection, palpation, and IOUS. The literature suggests that approximately 10% of insulinomas are neither visible nor palpable in bimanual examinations of the pancreas , so IOUS needs to be performed to raise this to 100% . One review showed that the range of sensitivity of inspection and palpitation combined was 41.7%–96.4%, and it was 62.5%–100% for IOUS .…”