Usefulness of selective arterial calcium injection test and secretin test in patients with insulinoma

Imamura, Masayuki; Shimada, Yutaka; Kato, Masayuki; Doi, R; Okada, Noriyuki; Hashimoto, Mituaki

doi:10.1007/bf01211915

Cited by 15 publications

(18 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.

View full text Add to dashboard Cite

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)

show abstract

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.

View full text Add to dashboard Cite

show abstract

“…Therefore, the serum insulin response to intra- venous secretin injection reflects both the decreased secretory activities of insulinoma cells and the suppressed secretory activities of residual β cells. The sensitivity and specificity of this test for the diagnosis of insulinoma is 75% and 100%, respectively [7,8]. Glaser et al described two patients with insulinomas whose clinical features were very similar to those of our patient [17].…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of insulinoma requires confirmation of hypoglycemia, evidence of inappropriate insulin secretion, and identification of a pancreatic mass by medical imaging or angiography [2][3][4][5]. The intravenous secretin injection test is useful for the diagnosis of insulinoma because of its high specificity (100%) and high sensitivity (75%) [6][7][8]. The use of C-peptide levels to assess of endogenous insulin secretion is also considered reliable for the diagnosis of insulinoma [9][10][11][12][13].…”

mentioning

confidence: 99%

A Case of Secretin-responsive Insulinoma with Low Serum C-peptide Levels

et al. 2007

View full text Add to dashboard Cite

Abstract. Insulinoma is the most common cause of fasting hypoglycemia resulting from autonomous insulin hypersecretion. A 59-year-old woman who had previously had an insulinoma and had undergone a partial pancreatectomy was admitted to our hospital because of recurrence of hypoglycemia after 27 years. She had two unusual endocrinological features: 1) the serum insulin response to intravenous secretin injection was not impaired, and 2) the serum C-peptide levels and ratios of serum C-peptide to insulin were relatively low. Two pancreatic tumors were readily detectable by computed tomography (CT) and magnetic resonance imaging (MRI). The selective arterial calcium injection (SACI) test showed a hyperinsulinemic response by calcium administration to the gastroduodenal artery. A partial pancreatectomy was done and her hypoglycemia disappeared. Histology revealed that the tumors were composed of monotonous, small round cells that were positive for both insulin and cathepsin B. As previous in vitro studies have shown that C-peptide can be metabolized within human insulinoma cells by proteolytic cleavage by cathepsin B, our patient's low serum C-peptide levels might have been caused by degradation of C-peptide by cathepsin B. According to the data from the literature, the molar ratio of serum C-peptide to insulin is generally decreased in patients with insulinoma than normal subjects. This case highlights the need for careful interpretation of C-peptide levels and the intravenous secretin injection test in the diagnosis of insulinoma.

show abstract

“…Intravenous secretin test for insulinoma: When 2 U/kg・body weight of secretin is intravenously administered, plasma insulin level rises more than 200% within 4 min in normal volunteers, but does not rise more than 100% in patients with insulinoma [16,17] . We have developed this test and used it for patients in whom other tests were non-diagnostic in the differential diagnosis of insulinoma.…”

Section: Inhibition Test and Stimulation Test For Diagnosis Of Symptomentioning

confidence: 99%

Recent standardization of treatment strategy for pancreatic neuroendocrine tumors

Imamura¹

2010

WJG

Self Cite

View full text Add to dashboard Cite

Recent advances in localization techniques, such as the selective arterial secretagogue injection test (SASI test) and somatostatin receptor scintigraphy have promoted curative resection surgery for patients with pancreatic neuroendocrine tumors (PNET). For patients with sporadic functioning PNET, curative resection surgery has been established by localization with the SASI test using secretin or calcium. For curative resection of functioning PNET associated with multiple endocrine neoplasia type 1 (MEN 1) which are usually multiple and sometimes numerous, resection surgery of the pancreas and/or the duodenum has to be performed based on localization by the SASI test. As resection surgery of PNET has increased, several important pathological features of PNET have been revealed. For example, in patients with Zollinger-Ellison syndrome (ZES), duodenal gastrinoma has been detected more frequently than pancreatic gastrinoma, and in patients with MEN 1 and ZES, gastrinomas have been located mostly in the duodenum, and pancreatic gastrinoma has been found to co-exist in 13% of patients. Nonfunctioning PNET in patients with MEN 1 becomes metastatic to the liver when it is more than 1 cm in diameter and should be resected after careful observation. The most important prognostic factor in patients with PNET is the development of hepatic metastases. The treatment strategy for hepatic metastases of PNET has not been established and aggressive resection with chemotherapy and trans-arterial chemoembolization have been performed with significant benefit. The usefulness of octreotide treatment and other molecular targeting agents are currently being assessed.

show abstract

Usefulness of selective arterial calcium injection test and secretin test in patients with insulinoma

Cited by 15 publications

References 7 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.

A Case of Secretin-responsive Insulinoma with Low Serum C-peptide Levels

Recent standardization of treatment strategy for pancreatic neuroendocrine tumors

Contact Info

Product

Resources

About