[Invasive diagnostic procedures for insulinomas of the pancreas].
Insulinomas are the most common cause for hypoglycemia with endogenous hyperinsulinism. Insulinomas are the most frequent endocrine tumor of the pancreas and 10% occur as multiple tumors (e.g. multiple endocrine neoplasia type I) or in rare cases as islet cell hyperplasia. A further 10-15% of insulinomas are malignant. Non-invasive imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and somatoreceptor scintigraphy (SRN) show a lower sensitivity for detection and localization of tumors, because in many cases insulinomas are smaller than 2 cm in size. Invasive pre-operative diagnostic procedures, such as transhepatic peripancreatic venous blood sampling (TPVB) and the intra-arterial calcium stimulation test (ASVS) are much more time-intensive compared to CT, MRI and US with an examination time of 2-3 h but achieve a more exact pre-operative detection and localization with sensitivities mostly greater than 95% and are therefore the diagnostic methods of choice.
Nöldge
G
G
Abt. Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland. gerd.noeldge@med.uni-heidelberg.de
Weber
M-A
MA
Ritzel
R A
RA
Werner
M J
MJ
Kauczor
H-U
HU
Grenacher
L
L
D000328:Adult; D000792:Angiography; D015901:Angiography, Digital Subtraction; D001800:Blood Specimen Collection; D002125:Calcium Gluconate; D002406:Catheterization, Peripheral; D003937:Diagnosis, Differential; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology; D007003:Hypoglycemia / Q000209:etiology; D007091:Image Processing, Computer-Assisted; D007328:Insulin / Q000097:blood*; D007340:Insulinoma / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010690:Phlebography; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D007328:Insulin; D002125:Calcium Gluconate