[Intra-arterial calcium stimulation for preoperative localization of insuloma].
OBJECTIVE
Objective is to evaluate the efficacy of the intraarterial calcium test in the preoperative localisation of insulinomas.


METHODS
To stimulate the pathological release of insulin, calcium gluconate (0.015 meq Ca++/kg) was selectively injected into the arteries supplying the pancreas. Prior to calcium injection and 30, 60, 90 and 120 seconds later, 5 ml samples of blood were obtained from the right or from both right and left hepatic veins. Insulin levels were then determined by mean of immunoassays. A twofold increase in insulin level in the venous sample after 30 or 60 seconds localised the insulinoma to the region of the pancreas supplied by the selectively injected artery. Results of the calcium test were prospectively analysed in 6 patients and compared with operative findings.


RESULTS
All 6 patients had a surgically proved solitary and benign insulinoma. Calcium stimulation with venous sampling provided true-positive localisation of insulinomas in all patients without suspicion of liver metastasis. All 6 patients currently have normal insulin levels after a mean period of 16 months (range 4-24 months) with no evidence of hypoglycaemia on fasting.


CONCLUSIONS
Intraarterial stimulation with calcium and hepatic vein samplings for insulin gradients is a very sensitive minimally invasive functional method and may replace transhepatic portal venous samplings for the preoperative detection of insulinomas.
Pereira
P L
PL
Klinik für Radiologie, Abteilung Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen. philippe.pereira@med.uni-tuebingen.de
Dammann
F
F
Schott
U
U
Huppert
P E
PE
Duda
S H
SH
Teichmann
R
R
Claussen
C D
CD
D000328:Adult; D000368:Aged; D002118:Calcium / Q000008:administration & dosage; D002125:Calcium Gluconate / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results
D007328:Insulin; D002125:Calcium Gluconate; D002118:Calcium
Intraarterieller Kalzium-Stimulationstest zur präoperativen Lokalisationsdiagnostik des Insulinoms.