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Localization of insulinomas by selective intraarterial calcium injection
D O'Shea1, A W Rohrer-Theurs, J A Lynn
1Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital London, United Kingdom.
The Journal of Clinical Endocrinology and Metabolism
|April 1, 1996
Summary
Selective intraarterial calcium injection with hepatic venous sampling effectively localizes insulinomas when imaging is inconclusive. This powerful diagnostic technique uses smaller calcium doses, potentially reducing hypoglycemia risks.
Area of Science:
- Endocrinology
- Interventional Radiology
- Diagnostic Imaging
Background:
- Insulinomas are rare pancreatic tumors causing hypoglycemia.
- Localization can be challenging, with standard imaging (ultrasound, CT) often equivocal.
- Accurate preoperative localization is crucial for successful surgical resection.
Observation:
- Seven patients with suspected insulinomas underwent selective intraarterial calcium injection and hepatic venous sampling.
- Standard imaging was negative or equivocal in all cases.
- Calcium gluconate was injected into pancreatic arteries, with serial insulin measurements from the hepatic vein.
Findings:
- The selective intraarterial calcium injection test successfully localized insulinomas in 5 out of 6 positive cases.
- A diagnostic insulin rise was observed in a single artery in most positive cases.
- A lower calcium dose than previously reported was effective and potentially safer.
Implications:
- Selective intraarterial calcium injection with hepatic venous sampling is a potent preoperative tool for insulinoma localization.
- Optimized calcium dosing may enhance safety and reduce procedural risks like hypoglycemia.
- This method aids in precise tumor identification, guiding surgical strategy and improving patient outcomes.