title: Preoperative localization of an insulinoma: selective arterial calcium stimulation test performance.
abstract: OBJECTIVE
  Preoperative localization of an insulinoma is recommended to improve the cure rate, but non-invasive procedures can fail to detect the tumour. The objective of the study was to assess the performance of a selective arterial calcium stimulation test in the preoperative localization of insulinomas that were not detected by conventional imaging procedures.
  
  
  METHODS
  We conducted a monocenter retrospective case review of 13 patients who had endogenous hyperinsulinism and were treated between 1994 and 2013. Patients were selected on the basis of negative or doubtful non-invasive preoperative imaging. A selective arterial calcium stimulation test was performed by pancreatic and hepatic arteriography with selective intra-arterial calcium stimulation and hepatic venous sampling in order to obtain the plasma insulin measurement. We evaluated the efficacy of the test by comparing the results with an endoscopic ultrasound.
  
  
  RESULTS
  Twelve of the 13 patients underwent surgery, and the presence of an insulinoma was proven in 11 patients by pathological analysis of the tumour. An endoscopic ultrasound was consistent with surgery in 71.4 % of cases, while selective arterial calcium stimulation was consistent with surgery in 90.9 % and allowed detection of an insulinoma in two additional patients with a negative endoscopic ultrasound. One false-negative and one false-positive arterial calcium test were observed. No adverse events were recorded except transient skin flush following calcium injection in one patient.
  
  
  CONCLUSIONS
  The selective arterial calcium stimulation test is a sensitive diagnostic procedure for localizing insulinomas and may be considered when non-invasive radiological imaging does not allow the detection of an occult insulinoma.
authors.affiliation: Endocrinology Unit, Centre Hospitalo-Universitaire de Caen, Avenue de la côte de Nacre, CS 30001, 14033, Caen Cedex 9, France.
authors.forename: J
authors.initials: J
authors.lastname: Morera
authors.affiliation: Endocrinology Unit, Centre Hospitalo-Universitaire de Caen, Avenue de la côte de Nacre, CS 30001, 14033, Caen Cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Guillaume
authors.affiliation: Diagnostic Radiology Unit, Centre Hospitalo-Universitaire de Caen, Avenue de la côte de nacre, CS 30001, 14033, Caen Cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Courtheoux
authors.affiliation: Endoscopic Ultrasound Unit, Trocadero Clinic, 75016, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Palazzo
authors.affiliation: Endocrinology Unit, Centre Hospitalo-Universitaire de Caen, Avenue de la côte de Nacre, CS 30001, 14033, Caen Cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Rod
authors.affiliation: Endocrinology Unit, Centre Hospitalo-Universitaire de Caen, Avenue de la côte de Nacre, CS 30001, 14033, Caen Cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Joubert
authors.affiliation: Endocrinology Unit, Centre Hospitalo-Universitaire de Caen, Avenue de la côte de Nacre, CS 30001, 14033, Caen Cedex 9, France. reznik-y@chu-caen.fr.
authors.forename: Y
authors.initials: Y
authors.lastname: Reznik
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000473:pathology*; D006801:Humans; D007269:Injections, Intra-Arterial; D007340:Insulinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods; D055815:Young Adult
chemical_list: D002118:Calcium
keywords: Angiography; Arteriography; Endocrine pancreatic tumour; Hyperinsulinemic hypoglycaemia