Localization of Multiple Pancreatic Insulinoma by Intra-arterial Calcium Stimulation with Hepatic Venous Sampling and Intra-operative Ultrasound Imaging: a Case Report

ER General; EC Cunanan; JD Uy; AS Crisaldo; CJV Fiemtebella; Jr Navarro; AG Tingcungco; RA Lopez; LB Mercado-Asis

International Journal of Endocrinology and Metabolism

Research Institute for Endocrine Sciences

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Localization of Multiple Pancreatic Insulinoma by Intra-arterial Calcium Stimulation with Hepatic Venous Sampling and Intra-operative Ultrasound Imaging: a Case Report

Author(s):

ER General^1,*,

EC Cunanan²,

JD Uy²,

AS Crisaldo²,

CJV Fiemtebella²,

Jr NS Navarro²,

AG Tingcungco²,

RA Lopez²,

LB Mercado-Asis²

1Section of Endocrinology and Metabolism University of Santo Tomas Hospital, edbertgeneralmd@yahoo.com, Philipines

2Section of Endocrinology and Metabolism University of Santo Tomas Hospital, Philipines

International Journal of Endocrinology and Metabolism:Vol. 5, issue 4; 207-213

Article type:Case Report

Received:Aug 17, 2007

Accepted:Oct 24, 2007

How to Cite:ER GeneralEC CunananJD UyAS CrisaldoCJV FiemtebellaJr NS NavarroAG TingcungcoRA LopezLB Mercado-Asiset al.Localization of Multiple Pancreatic Insulinoma by Intra-arterial Calcium Stimulation with Hepatic Venous Sampling and Intra-operative Ultrasound Imaging: a Case Report.Int J Endocrinol Metab.5(4):207-213.

Abstract

Insulinoma is a rare neuroendocrine tumor with an incidence of approximately 4 per 5 million population. They are typically sporadic, solitary and less than 2 cm in diameter. Despite the in-troduction of sophisticated cross-imaging tech-niques such as CT scan, MRI and ultrasound, lo-calization of insulinomas, especially those smaller than 2 cm remains a problem; for this, one can localize insulinoma by stimulating re-lease of insulin using selective intra-arterial in-jection of calcium and subsequent measurement of insulin levels in the hepatic veins. We report here a case of multiple pancreatic insulinomas measuring 3.0 x 2.1 x 2.0 cm ( head) and 1.0 x 0.8 x 0.3 cm (body) not seen by imaging techniques but localized by intra-arterial calcium stimula-tion with hepatic venous sampling and intraop-erative ultrasound imaging. This is the first se-lective intra-arterial calcium stimulation with hepatic venous sampling for localization of pan-creatic insulinoma in the Philippines.

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