Diagnosis and Localization of Insulinoma After Negative Laparotomy by Hyperinsulinemic, Hypoglycemic Clamp and Intra-Arterial Calcium Stimulation

摘要: A 40-year-old woman with recurrent episodes of hypoglycemia was referred because suspected insulinoma. Prolonged fasting discontinued after 24 h due to symptomatic (29 mg/dl, glucose/insulin-ratio 0.34). Magnetic resonance tomography showed a small 0.3 cm lesion in the body pancreas. During subsequent surgery pancreatic tumor could not be detected, neither by manual palpation nor intraoperative ultrasonography. hyperinsulinemic, sequentially eu- and hypoglycemic clamp confirmed biochemical diagnosis endogenous hyperinsulinemia intra-arterial calcium stimulation localized responsive tissue feeding distribution superior mesenteric artery. An octreotide scan negative. relaparotomy, six weeks initial surgery, tail were resected approximately 1 non-malignant insulinoma found. Although use highly sensitive, more sophisticated expensive methods for localization insulinomas are generally suggested, we recommend application if is detected using conventional diagnostic procedures.