title: Intra-arterial calcium stimulation test with hepatic venous sampling for preoperative diagnosis of a large insulinoma in an obese young man.
abstract: Herein, we report the case of a large benign insulinoma in an obese young man with a three-year history of asymptomatic hypoglycaemia. He presented to our outpatient department with a two-week history of dizziness and morning cold sweats. A random serum glucose test revealed hypoglycaemia. Upon admission, computed tomography and magnetic resonance imaging of the abdomen with intravenous contrast media showed an enhancing mass lesion in the uncinate process of the pancreas. To confirm the diagnosis, an intra-arterial calcium stimulation test with hepatic venous sampling was performed for preoperative localisation and to exclude the presence of occult insulinomas. The patient underwent an exploratory laparotomy, with successful resection of the pancreatic head tumour. Histology confirmed the diagnosis of insulinoma. The patient's postoperative recovery was uneventful, and he has not developed further episodes of hypoglycaemia three years post surgery.
authors.forename: Ya-Cheng
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Centre, No. 325, Sec 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. Cute10627@yahoo.com.tw.
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Liu
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Yu
authors.forename: Guo-Shu
authors.initials: GS
authors.lastname: Huang
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002118:Calcium / Q000378:metabolism*; D003287:Contrast Media / Q000737:chemistry; D006503:Hepatic Veins / Q000473:pathology*; D006801:Humans; D007340:Insulinoma / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D009765:Obesity / Q000097:blood* / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
chemical_list: D001786:Blood Glucose; D003287:Contrast Media; D002118:Calcium