[Localizing of Langerhans islets adenoma by transhepatic portal catheterization].
BACKGROUND
The procedures used to locate pancreatic endocrine tumors have only limited success in infants and children in whom the nodules may be small. Portal catheterization may therefore be useful.


METHODS
A child aged 6 yrs 4 months was admitted because of several recent episodes of pallor and sweating associated with hypoglycemia. Further investigation showed moderate hyperinsulinemia and low blood levels of ketone bodies and branched amino-acids after a 15 hr fast. Celiac angiography was normal. The hypoglycemic episodes recurred despite treatment with diazoxide for 6 months. A transparietal portal catheterization was therefore performed. Selective pancreatic venous sampling showed high concentrations of insulin in two small veins draining one part of the head of the pancreas (117 and 89 microU/ml). The head of pancreas was removed 16 months later. Extemporaneous examination revealed an adenoma 0.8 cm in diameter. This patient has completely recovered, 8 months after surgery.


CONCLUSIONS
Transparietal portal catheterization can detect pancreatic areas with high insulin secretion. It may also help the interpretation of celiac angiographs in children, as diagnosis may be obscured by the normal rich vascularity of the pancreas in these patients.
Zeller
J
J
Service d'Endocrinologie, Hôpital St-Vincent-de-Paul, Paris.
Roche
A
A
Rahier
J
J
Adamsbaum
C
C
Carel
J C
JC
Hélardot
P
P
Bougnères
P F
PF
D007516:Adenoma, Islet Cell / Q000175:diagnosis* / Q000378:metabolism; D000792:Angiography; D002406:Catheterization, Peripheral; D002648:Child; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D008297:Male; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D011169:Portal Vein
D007328:Insulin
Localisation d'un adénome langerhansien par cathétérisme portal transhépatique.