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 insuli...

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Bibliographic Details
Published in:Radiologe 2009-03, Vol.49 (3), p.224
Main Authors: Nöldge, G, Weber, M-A, Ritzel, R A, Werner, M J, Kauczor, H-U, Grenacher, L
Format: Article
Language:ger
Subjects:
Adult
Angiography
Angiography, Digital Subtraction
Blood Specimen Collection
Calcium Gluconate
Catheterization, Peripheral
Diagnosis, Differential
Hepatic Artery - diagnostic imaging
Hepatic Veins - diagnostic imaging
Humans
Hyperinsulinism - etiology
Hypoglycemia - etiology
Image Processing, Computer-Assisted
Insulin - blood
Insulinoma - blood supply
Insulinoma - diagnosis
Insulinoma - pathology
Insulinoma - surgery
Male
Neoplasm Invasiveness
Pancreatic Neoplasms - blood supply
Pancreatic Neoplasms - diagnosis
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Phlebography
Sensitivity and Specificity
Tomography, X-Ray Computed
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Summary: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.
ISSN:1432-2102
DOI:10.1007/s00117-008-1786-7