title: High-dose calcium stimulation test in a case of insulinoma masquerading as hysteria.
abstract: It is reported that some cases with insulinoma present with neuropsychiatric symptoms and are often misdiagnosed as psychosis. Here we report a case of insulinoma masquerading as hysteria, whose final diagnosis could be made using high-dose calcium stimulation test. A 28-yr-old woman was referred presenting with substupor, mutism, mannerism, restlessness, and incoherence. Laboratory examinations revealed hypoglycemia (33 mg/dL) and detectable insulin levels (9.7 microU/mL), suggesting the diagnosis of insulinoma. However, neither imaging studies nor selective arterial calcium injection (SACI) test with a conventional dose of calcium (0.025 mEq/kg) indicated the tumor. High-dose calcium injection (0.05 mEq/kg) evoked insulin secretion when injected into superior mesenteric artery. A solitary tumor in the head of the pancreas was resected, and her plasma glucose returned to normal. Postoperatively, iv injection of secretin resulted in a normal response of insulin, which was not found preoperatively. This case suggests the usefulness of the SACI test with high-dose of calcium in the case of insulinoma when the standard dose fails to detect such a tumor.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan. nkmr@amahosp.amagasaki.hyogo.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Doi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kohno
authors.forename: Dai
authors.initials: D
authors.lastname: Shimono
authors.forename: Naomitsu
authors.initials: N
authors.lastname: Kuwamura
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koshiyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000328:Adult; D002118:Calcium / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007046:Hysteria / Q000175:diagnosis*; D007150:Immunohistochemistry; D007328:Insulin / Q000378:metabolism; D007340:Insulinoma / Q000175:diagnosis* / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D007328:Insulin; D002118:Calcium