The role of calcium‐stimulated venous sampling in the surgical treatment of multiple neuroendocrine neoplasms. Case report

Abstract

Insulinoma is a functioning pancreatic neuroendocrine tumour (pNET) that produces insulin, which causes clinical symptoms of severe hypoglycemia (Whipple's triad). 1,2 Surgery is the only effective way for the treatment of this group of neoplasms. There are no universal surgical tactics in cases of multiple neuroendocrine tumours. In such cases, selective arterial calcium stimulation with hepatic venous sampling (ASVS) can localise the insulin-producing tumour and help to avoid an excessive volume of surgery.The patient, a 60-year-old female, complained of episodes of fainting, weakness, anxiety, sweating and dizziness due to severe hypoglycemia. Symptoms had been contained by intake of simple carbohydrates. The first episode of hypoglycemia occurred 18 months before admission. Since that time, her weight has increased by 9 kg. Hypoglycemia of 1.1 mmol/L was detected. In January 2020 Pituitary carcinomas (PC) are very rare tumours that are defined by their metastatic status. Several authors have recently suggested that pituitary tumours, which are in the vast majority of cases adenomas, should be considered as pituitary neuroendocrine tumours (PitNETs) and be managed as neuroendocrine tumours (NET) of other origins. 1,2 As PCs are rare, data on therapeutic strategies remain scarce. Systemic treatments