title: Arterial stimulation and venous sampling for glucagonomas of the pancreas.
abstract: OBJECTIVE
  Arterial stimulation and venous sampling (ASVS) is a catheter-based diagnostic technique used to identify the localization of an insulinoma or gastrinoma. The aim of this study was to clarify the clinical significance of ASVS for glucagonomas.
  
  
  METHODS
  Eight patients with pancreatic hypervascular tumors and elevated serum glucagon levels in the peripheral blood were enrolled. Pancreatic angiography was performed and a bolus dose of calcium was injected into a suitable artery. Hepatic venous blood samples were then obtained to measure concentrations of glucagon and insulin. All patients underwent surgical resection, and the resected specimens were investigated immunohistochemically.
  
  
  RESULTS
  Compared to insulin, the glucagon levels stabilized after calcium stimulation in four patients, with a 1.2-fold increase or decrease. In the remaining four patients, there was a 1.6- to 5.8-fold increase in glucagon levels. The peak value of glucagon was observed at 90s or 120s which was slower than the insulin peak observed in patients with insulinoma. The patients with elevated glucagon levels during ASVS exhibited positive immunostaining of glucagon in resected specimens.
  
  
  CONCLUSIONS
  Increase in glucagon after calcium stimulation was observed in patients with glucagonomas. ASVS for glucagonomas may be useful in determining the most suitable surgical procedure.
authors.affiliation: Department of Surgery, Osaka University, Osaka, Japan. heguchi@gesurg.med.osaka-u.ac.jp
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanemura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Kohei
authors.initials: K
authors.lastname: Okita
authors.forename: Hiromi
authors.initials: H
authors.lastname: Iwahashi
authors.forename: Akihisa
authors.initials: A
authors.lastname: Imagawa
authors.forename: Iichiro
authors.initials: I
authors.lastname: Shimomura
authors.forename: Keigo
authors.initials: K
authors.lastname: Osuga
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Wakasa
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002125:Calcium Gluconate / Q000008:administration & dosage; D002406:Catheterization, Peripheral; D005260:Female; D005934:Glucagon / Q000097:blood*; D005935:Glucagonoma / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D007150:Immunohistochemistry; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D007564:Japan; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D018579:Patient Selection; D011237:Predictive Value of Tests; D011859:Radiography; D013157:Splenic Artery / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D014408:Biomarkers, Tumor; D007328:Insulin; D005934:Glucagon; D002125:Calcium Gluconate