Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling

Zhao, Ken; Patel, Nihal; Kulkarni, Kiran Abhijit; Gross, Jonathan; Taslakian, Bedros

doi:10.3390/jcm9103091

Cited by 12 publications

(10 citation statements)

References 70 publications

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“…Radiological identification of an insulinoma is challenging and the symptoms usually precede the occurrence of a visible tumor (7). Even though, endoscopic ultrasound has a satisfactory accuracy in the detection of insulinoma, its use is limited in the local setting due to poor availability(8) SACST is a highly sensitive dynamic test that can localize an insulinoma with an 80%-94% of accuracy (9). It is possible to miss an occult tumor even during the surgical exploration as presented in this case.…”

Section: Discussionmentioning

confidence: 99%

Importance of Selective Arterial Calcium Stimulation with Hepatic Venous Sampling in Management of a Patient with Multifocal Insulinoma

Ubhayasiri

Premawansa

2022

SL J. Med.

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Insulinoma is a rare neuroendocrine tumour arising from beta cells of pancreatic islets of Langerhans. We report a case of insulinoma presented with vague manifestations, which were undiagnosed for 2 years. The diagnostic evaluation revealed endogenous hyperinsulinism and imaging showed a pancreatic head lesion for which she underwent the surgery. Due to persisting symptoms, Calcium arterial stimulation and hepatic venous sampling was later performed and it localized an occult insulinoma that was not visible during the radiological or surgical assessment. Diagnosis of occult insulinomas remains a clinical challenge. Selective arterial calcium stimulation and venous sampling is a reliable pre-operative procedure for the positive diagnosis of insulinoma.

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Section: Discussionmentioning

confidence: 99%

Importance of Selective Arterial Calcium Stimulation with Hepatic Venous Sampling in Management of a Patient with Multifocal Insulinoma

Ubhayasiri

Premawansa

2022

SL J. Med.

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“…SACST is based on the fact that calcium stimulates the release of insulin from hyperfunctioning, abnormal pancreatic β cells, but not from normal β cells. Therefore, at least a twofold increase in hepatic venous insulin concentration over baseline following calcium injection into a single pancreatic artery is considered the criteria to localize an occult insulinoma ( 4 ) with high sensitivity (67–100%) ( 5 ). Positivity in more than one artery at SACST may be suggestive of diffuse nesidioblastosis, but will not reliably differentiate between nesidioblastosis and insulinoma, particularly in the presence of multiple tumors, such as in multiple endocrine neoplasia type 1, or in the case of overlapping pancreatic arterial distributions.…”

Section: Discussionmentioning

confidence: 99%

Adult-onset nesidioblastosis: a challenging diagnosis revealed by glucagon-like-peptide-1 receptor imaging

Demartin

Goffette

Christ

et al. 2022

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary A 52-year-old female presented with recurrent episodes of fasting or post-absorptive hypoglycemia. A 72-h fasting test confirmed endogenous hyperinsulinemia. Conventional imaging was unremarkable. Selective pancreatic arterial calcium stimulation and hepatic venous sampling showed a maximum calcium-stimulated insulin concentration from several pancreatic areas, mainly the proximal splenic artery and the proximal gastroduodenal artery, suggesting the presence of one or more occult insulinoma(s) in the region of the pancreatic body. 68Ga-DOTA-exendin-4 PET/CT showed however generalized increased uptake in the pancreas and a diagnosis of nesidioblastosis was therefore suspected. The patient has been since successfully treated with dietetic measures and diazoxide. Treatment efficacy was confirmed by a flash glucose monitoring system with a follow-up of 7 months. Learning points Adult nesidioblastosis is a rare cause of endogenous hyperinsulinemic hypoglycemia. The distinction between insulinoma and nesidioblastosis is essential since the therapeutic strategies are different. 68Ga-DOTA-exendin-4 PET/CT emerges as a new noninvasive diagnostic tool for the localization of an endogenous source of hyperinsulinemic hypoglycemia. Medical management with dietetic measures and diazoxide need to be considered as a valuable option to treat patients with adult nesidioblastosis. Flash glucose monitoring system is helpful for the evaluation of treatment efficacy.

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“…[6] SACST jest skuteczną, bezpieczną i czułą (93%) minimalnie inwazyjną procedurą lokalizacji insulinoma, która może być stosowana w przypadku, gdy techniki nieinwazyjne są niejednoznaczne lub u pacjentów z zespołem MEN1. [7][8] Nową i bardzo obiecującą techniką jest pozytonowa emisyjna tomografia komputerowa (PET-CT) receptora glukagonopodobnego peptydu 1 (GLP-1R). Skuteczno tej metody szacuje się na na ponad 90%.…”

Section: Diagnostykaunclassified

Insulinoma - review of characteristics, diagnosis and treatment

Sapuła

Remjasz²,

Siedlecki

et al. 2022

J Educ Health Sport

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Introduction and purpose: Insulinoma is one of a group of pancreatic neuroendocrine neoplasms (NENs). This tumor has its origin in the β cells of the pancreatic islets, which are responsible for the production of insulin. Excessive amounts of this hormone in the body manifest hypoglycemic neuroglycopenic and sympathetic-overstimulation symptoms. The purpose of this review is to analyze information on the characteristics, diagnosis and treatment of patients with insulinoma. Material and methods: This review was based on available data collected in the PubMed database and published between 2017 and 2022. The study was conducted by reviewing keywords as follows: "insulinoma," "NEN," "diagnosis," and "treatment." Results: The diagnosis of insulinoma consists of a typical clinical presentation, biochemical test results indicating hyperinsulinemic hypoglycemia, and presence of a tumor. The treatment targets solutions leading to a complete recovery, usually performing open surgery involving enucleation of the tumor. Conclusions: Despite the characteristic clinical picture, insulinoma is still often a diagnostic problem. It is necessary to work towards improving diagnostic methods and conduct further research into the most effective methods of treating insulinoma.

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Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling

Cited by 12 publications

References 70 publications

Importance of Selective Arterial Calcium Stimulation with Hepatic Venous Sampling in Management of a Patient with Multifocal Insulinoma

Importance of Selective Arterial Calcium Stimulation with Hepatic Venous Sampling in Management of a Patient with Multifocal Insulinoma

Adult-onset nesidioblastosis: a challenging diagnosis revealed by glucagon-like-peptide-1 receptor imaging

Insulinoma - review of characteristics, diagnosis and treatment

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