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[Localizing of Langerhans islets adenoma by transhepatic portal catheterization]
Insights
Transparietal portal catheterization effectively located a small pancreatic endocrine tumor in a child with hypoglycemia. This method aids in diagnosing insulinomas when other techniques fail, leading to successful surgical removal and recovery.
Area of Science:
- Pediatric Endocrinology
- Diagnostic Imaging
- Surgical Oncology
Background:
- Locating small pancreatic endocrine tumors in children is challenging.
- Standard imaging techniques have limited success in pediatric patients.
- Portal catheterization offers a potential solution for improved localization.
Background:
The procedures used to locate pancreatic endocrine tumors have only limited success in infants and children in whom the nodules may be small. Portal catheterization may therefore be useful.
Case Report:
A child aged 6 yrs 4 months was admitted because of several recent episodes of pallor and sweating associated with hypoglycemia. Further investigation showed moderate hyperinsulinemia and low blood levels of ketone bodies and branched amino-acids after a 15 hr fast. Celiac angiography was normal. The hypoglycemic episodes recurred despite treatment with diazoxide for 6 months. A transparietal portal catheterization was therefore performed. Selective pancreatic venous sampling showed high concentrations of insulin in two small veins draining one part of the head of the pancreas (117 and 89 microU/ml). The head of pancreas was removed 16 months later. Extemporaneous examination revealed an adenoma 0.8 cm in diameter. This patient has completely recovered, 8 months after surgery.
Conclusion:
Transparietal portal catheterization can detect pancreatic areas with high insulin secretion. It may also help the interpretation of celiac angiographs in children, as diagnosis may be obscured by the normal rich vascularity of the pancreas in these patients.