Does conventional abdominal preoperative ultrasonography have a role in the detection of pancreatic insulinoma? A case report
- 1
- 2
- 3
- 4
Abstract
Combinations of strategies as MRI, endoscopic sonography, selective arteriography, were the first choice for the detection of pancreatic insu-linoma. In these proposal, therefore, abdominal was not in- cluded at all. Case presentation: a 78-year-old no diabetic women was referred to us because fasting hypoglycemic symptoms. The clinical and laboratory findings suggested an insulinoma. Abdominal ultrasound showed a small solid mass in the head-istmus pancreatic tract. Conclusion: the solid mass was confirmed with a contrast-enhanced- computed tomogra-phy of the abdomen. A surgical enucleation of the tumor was achieved by laparoscopy and histological examination of the specimen estab-lished a diagnosis of insulinoma. This case re-inforced the value of the conventional trans- abdomen ultrasound in addition to accuracy of anamneses and biochemical tests as the first step in the hospital clinical setting for man-agement of pancreatic insulinoma, reserving as the second step more expensive and invasive-ness techniques.
- Service, F.J., McMahon, M.M., O’Brien, P.C., et al. (1991) Functioning insulinoma: incidence, recurrence, and long term survival of patients: a 60-years study. Mayo Clin Proc, 66, 711-719.
- Virally, M.L., Guillausseau, P.J. (1999) Hypoglycemia in adults. Diabetes e Metabolism, 25, 477-490.
- Catalano, C., Pavone, P., Laghi, A., et al. (1999) Local-ization of pancreatic insulinomas with MR imaging at 0.5 T. Acta Radiol, 39, 644-648.
- Moore, N.R., Rogers, C.E., Britton, B.J. (1995) Magnetic resonance imaging of endocrine tumors of the pancreas. Br J Radiol, 68, 341-347.
- Gouya, H., Vignaux, O., Augui, J., Dousset, B., Palazzo, L., Louvel, A., Chaussade, S., Legmann, P. (2003) CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR, 181, 987-992.
- Schumacher, B., Lubke, H.J., Frieling, T., Strohmeyer, G., Starke, A.A. (1996) Prospective study on the detection of insulinomas by endoscopic ultrasonography. Endoscopy, 28, 273-276.
- Liu, T.H., Tseng, H.C., Zhu, Y., Zhong, S.X., Chen, J., Cui, Q.C. (1985) Insulinoma: an immunohistochemical and morphologic analysis of 95 cases. Cancer, 56, 1420-1429.
- Stefanini, P., Carboni, M., Patrassi, N., Basoli, A. (1974) Beta islet-cell tumors of the pancreas: result of a study on 1067 cases. Surgery, 75, 597-609.
- Villary, M.L., Guillausseau, P.J. (1999) Review: Hypoglycemia in adults. Diabetes & Metabolism, 25, 477-490.
- Schwartz, N.S., Clutter, W.E., Shah, S.D., Cryer, P.E. (1987) Glycemic thresholds for activation of glucose counterregulatory systems are highter than the threshold for symptoms. J Clin Invest, 79, 777-781.
- Mitrakou, A., Ryan, C., Veneman, T., et al. (1991) Hier-rarchy of glycemic thresholds counterregulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol, 260, E67-E74.
- Cyper, P.E. (1993) Glucose counterregulation: the physiological mechanisms that prevent or correct hypoglycaemia. In: Frier, B.M., Fisher, B.M., (eds.), Hypoglycaemia and Diabetes: Clinical and Physiological Aspects. Edward Arnold, London, 34-55.
- Service, F.J. (1995) Review: Hypoglycemic disorders.. NEJM, 332, 1144-1152.
- Placzkowski, K.A., Vella, A., Thompson, G.B., Grant, C.S., Reading, C.C., Charboneau, J.W., Andrews, J.C., Lloyd, R.V., Service, F.J. (2009) Secular trends in the presentation an management of functioning insulinoma at the majp clinic, 1987-2007. J Clin Endocrinol Metab.