Insulinoma: Selective arterial calcium injection performed to confirm localization and complete resection |
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Authors: | Seiji Yano Shoichiro Sumi Yoshinori Nio Tatsuro Ooishi Yasunari Kawabata Yoshimitsu Minari and Katsuhiro Tamura |
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Institution: | (1) First Department of Surgery, Shimane Medical University, 89-1 Enyacho, 693 Izumo, Japan |
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Abstract: | A case of insulinoma is reported in a patient in whom selective arterial calcium injection (SACI) tests were performed both
to confirm tumor localization before surgery and to confirm complete tumor removal during surgery. An 18-year-old woman with
hypoglycemic episodes was diagnosed with an insulinoma in the pancreatic body demonstrated by celiac arteriography. In a preoperative
SACI test, calcium was injected into the splenic artery (SpA), gastroduodenal artery (GDA), and superior mesenteric artery
(SMA). Serum immunoreactive insulin (IRI) and proinsulin levels were measured in hepatic venous samples. IRI was markedly
increased after the injection of calcium into the GDA and SMA, while there was no response in IRI levels when calcium was
injected into the SpA. Therefore, no occult insulinoma was revealed in the distal area fed by the SpA, although the presence
of insulinoma was uncertain in the proximal pancreas. In the intraoperative SACI test, calcium was injected into the celiac
artery. Insulin (determined by enzyme immunoassay) and proinsulin levels were measured in portal venous samples before and
after resection of the tumor. After resection, these levels decreased in response to the calcium stimuli, confirming complete
removal of the insulinoma. The SACI test was helpful to localize the insulinoma and was useful to confirm the complete removal
of the tumor. |
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Keywords: | insulinoma selective arterial calcium injection (SACI) insulin (EIA) |
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