title: Endoscopic ultrasound localization of a pancreatic insulinoma: case report and review of the localization techniques.
abstract: A 23-year-old male was referred to our hospital for evaluation of new-onset seizures. Signs and symptoms of neuroglycopenia, including weakness, dizziness, and confusion, appeared during fasting and resolved promptly with intravenous dextrose administration. Insulin, proinsulin, and C-peptide levels were consistent with a diagnosis of insulinoma. Screening tests for multiple endocrine neoplasia type 1 and surreptitious sulfonylurea uses were negative. Preoperative localization of the insulinoma by transabdominal ultrasonography, computed tomography, and indium-111 octreoscanning were unsuccessful. Endoscopic ultrasonography (EUS) identified a 6- to 7-mm tumor at the juncture of the head and body of the pancreas. Surgical exploration confirmed the preoperative localization, and an 8-mm tumor was simply enucleated. The patient has been free of symptoms for 18 months since surgery. This report describes the utility of EUS to localize a solitary pancreatic insulinoma and provides a comparison of EUS and other preoperative localization techniques.
authors.affiliation: Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Hall
authors.forename: J F
authors.initials: JF
authors.lastname: Hanley
authors.forename: W
authors.initials: W
authors.lastname: Georgitis
authors.forename: P R
authors.initials: PR
authors.lastname: McNally
mesh_terms: D000328:Adult; D000792:Angiography; D019160:Endosonography / Q000379:methods* / Q000592:standards; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology*; D006801:Humans; D007340:Insulinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008889:Military Personnel; D015282:Octreotide / Q000031:analogs & derivatives; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards
chemical_list: C094279:indium-111-octreotide; D015282:Octreotide