Insulin-Secreting Tumor of the Pancreas

Johnston, Robin; Goetz, Frederick C.; Zimmermann, Bernard

doi:10.1056/nejm196012292632606

Cited by 25 publications

(1 citation statement)

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“…The intravenous tolbutamide test though usually innocuous is not completely without danger (Davidson, 1965;Samols and Marks, 1967), and the suggestion has been made (Johnston, Goetz, and Zimmermann, 1960) that it should be reserved 'for use in doubtful cases in which it is unlikely that a tumour is present'. Whilst we do not agree with this reservation, we consider it important that both intravenous glucose and hydrocortisone (100mg) should be at hand for terminating hypoglycaemic coma should it develop during the test .…”

Section: Discussionmentioning

confidence: 99%

Glucagon test for insulinoma: a chemical study in 25 cases

Marks¹,

Samols²

1968

J Clin Pathol

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SYNOPSISThe capillary blood glucose response to lmg of intramuscular glucagon was determined in 13 patients with insulinoma and in 33 normal controls; the insulinoma patients showed a normal initial rise, but this was followed by an abnormally large fall, reaching hypoglycaemic levels between 90 and 180 minutes in every case. In 14 insulinoma patients the response of venous blood glucose and also plasma insulin to lmg of intravenous glucagon was compared with 10 normal controls; there was an abnormally large rise of plasma insulin in 10 of the 14 patients, and in the majority the venous blood glucose was below normal throughout the test. In these 14 patients the plasma insulin response was also determined after oral and intravenous glucose, after oral leucine, and after intravenous tolbutamide, and the value of these tests in the recognition and differential diagnosis of insulinoma was compared with that of the intravenous glucagon test. MATERIALS AND METHODSTwenty-five patients with hyperinsulinism were studied, two of them (A.B. and W.K.) on more than one occasion. In 24 patients an insulinoma was found at operation; 18 were benign and five were malignant with metastases. The remaining patient (W.K.), who at first refused operation, was operated upon four years later but no tumour found though clinically the diagnosis was not in doubt; both fasting hypoglycaemia and hyperinsulinaemia persisted postoperatively. In addition two patients with hypoglycaemia due to extrapancreatic neoplasms, four with hepatogenous hypoglycaemia, three with essential reactive hypoglycaemia, and one with hypoglycaemia due to hypopituitarism were also studied.Control subjects were healthy laboratory personnel, or non-obese, non-diabetic hospital inpatients free from endocrine, hepatic, or metabolic disease. In addition five healthy, obese, non-diabetic subjects were investigated.Glucagon tests were carried out on patients and controls maintained on a high carbohydrate diet by one of the following procedures.

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Section: Discussionmentioning

confidence: 99%