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

authors:

avatar ER General 1 , * , avatar EC Cunanan 2 , avatar JD Uy 2 , avatar AS Crisaldo 2 , avatar CJV Fiemtebella 2 , avatar Jr NS Navarro 2 , avatar AG Tingcungco 2 , avatar RA Lopez 2 , avatar LB Mercado-Asis 2

Section of Endocrinology and Metabolism University of Santo Tomas Hospital, [email protected], Philipines
Section of Endocrinology and Metabolism University of Santo Tomas Hospital, Philipines

how to cite: General E, Cunanan E, Uy J, Crisaldo A, Fiemtebella C, et 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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