Nakamura Yoshio, Doi Ryuichiro, Kohno Yasuhiro, Shimono Dai, Kuwamura Naomitsu, Inoue Koichi, Koshiyama Hiroyuki, Imamura Masayuki
Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan.
Endocrine. 2002 Nov;19(2):127-30. doi: 10.1385/ENDO:19:2:127.
It is reported that some cases with insulinoma present with neuropsychiatric symptoms and are often misdiagnosed as psychosis. Here we report a case of insulinoma masquerading as hysteria, whose final diagnosis could be made using high-dose calcium stimulation test. A 28-yr-old woman was referred presenting with substupor, mutism, mannerism, restlessness, and incoherence. Laboratory examinations revealed hypoglycemia (33 mg/dL) and detectable insulin levels (9.7 microU/mL), suggesting the diagnosis of insulinoma. However, neither imaging studies nor selective arterial calcium injection (SACI) test with a conventional dose of calcium (0.025 mEq/kg) indicated the tumor. High-dose calcium injection (0.05 mEq/kg) evoked insulin secretion when injected into superior mesenteric artery. A solitary tumor in the head of the pancreas was resected, and her plasma glucose returned to normal. Postoperatively, iv injection of secretin resulted in a normal response of insulin, which was not found preoperatively. This case suggests the usefulness of the SACI test with high-dose of calcium in the case of insulinoma when the standard dose fails to detect such a tumor.
据报道，一些胰岛素瘤病例表现为神经精神症状，常被误诊为精神病。在此我们报告一例伪装成癔症的胰岛素瘤病例，其最终诊断可通过高剂量钙刺激试验做出。一名28岁女性因出现亚木僵、缄默、怪癖、烦躁不安和言语紊乱而前来就诊。实验室检查显示低血糖（33mg/dL）且胰岛素水平可检测到（9.7微单位/毫升），提示胰岛素瘤诊断。然而，影像学检查和常规剂量钙（0.025mEq/kg）的选择性动脉钙注射（SACI）试验均未显示肿瘤。当向上肠系膜动脉注射高剂量钙（0.05mEq/kg）时可诱发胰岛素分泌。切除了胰腺头部的一个孤立肿瘤，她的血糖恢复正常。术后，静脉注射胰泌素导致胰岛素出现正常反应，而术前未发现此反应。该病例表明，当标准剂量未能检测到胰岛素瘤时，高剂量钙的SACI试验对胰岛素瘤病例有用。
