title: Intraoperative gamma probe detection of insulinoma in an elderly patient with pancreatic cystic lesions.
abstract: Insulinoma is a rare endocrine tumour in the elderly. We report the case of an 81-year-old woman suffering from grand mal seizures. Insulinoma was suspected because plasma glucose and insulin levels were 1.5 mmol/l and 80.4 pmol/l, respectively. A pancreatic computerized tomography (CT) scan, magnetic resonance imaging (MRI) and arteriography were normal but (111)In-DTPA-octreotide scintigraphy detected a hotspot in the pancreatic tail. Intraoperative pancreatic ultrasonography and palpation were non-contributory due to multiple pancreatic cysts and nodular lesions. However, a gamma-detecting probe localized a small tumour, labelled preoperatively with (111)In-DTPA-octreotide. Intraoperative insulin measurements in portal venous blood confirmed the successful removal of an insulinoma that was 6 mm in diameter histologically. Pancreatic cystic lesions increase with age and make the intraoperative localization of the insulinoma difficult. Intraoperative gamma probe detection of the tumour labelled with (111)In-DTPA-octreotide might therefore constitute a useful surgical tool.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D007340:Insulinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D007432:Intraoperative Period; D015282:Octreotide / Q000031:analogs & derivatives*; D010181:Pancreatic Cyst / Q000175:diagnosis; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
chemical_list: D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; C071632:SDZ 215-811; D004369:Pentetic Acid; D015282:Octreotide