Defreyne L, Moser C, Scheidt T, Kubale R, Meessen S, Koch B, Kramann B
Abteilung für Radiodiagnostik, Universität des Saarlandes, Homburg.
Dtsch Med Wochenschr. 1992 Nov 27;117(48):1829-37. doi: 10.1055/s-2008-1062517.
Blood-sugar levels below 40 mg/dl were measured during syncope in two female patients (aged 59 and 73 years). Suspected organic hyperinsulinism was confirmed by a fasting test. Ultrasound examination and computed tomography failed to demonstrate an insulinoma. Coeliacomesentericography was then undertaken together with a selective intra-arterial calcium provocation test of the pancreas (0.4 or 0.5 mmol calcium in physiological saline was injected into the pancreas-supplying arteries--proximal and distal splenic, superior mesenteric and gastroduodenal). The insulin level was determined in simultaneously obtained hepatic venous blood. In case 1, the insulin level rose tenfold after calcium injection into the proximal splenic artery, indicating a process in the body of the pancreas. In case 2, a steep rise in insulin occurred after injection into the truncus coeliacus and the proximal and distal splenic artery, suggesting an insulinoma in the tail of the pancreas. The site of the insulinoma was confirmed in both cases at surgery. The adenoma was enucleated in case 1, removed by partial resection of the tail of the pancreas in case 2.--These observations show that occult insulinomas can be localized preoperatively by intraarterial calcium injection with measurement of insulin concentration in simultaneously obtained hepatic venous blood.
两名女性患者（年龄分别为59岁和73岁）在晕厥期间测得血糖水平低于40mg/dl。通过禁食试验确诊为疑似器质性高胰岛素血症。超声检查和计算机断层扫描未能显示胰岛素瘤。随后进行了腹腔肠系膜造影，并对胰腺进行了选择性动脉内钙激发试验（将0.4或0.5mmol钙溶于生理盐水中注入供应胰腺的动脉——脾动脉近端和远端、肠系膜上动脉和胃十二指肠动脉）。同时测定肝静脉血中的胰岛素水平。病例1中，向脾动脉近端注入钙后胰岛素水平升高了10倍，提示胰腺体部存在病变。病例2中，向腹腔干、脾动脉近端和远端注入钙后胰岛素急剧升高，提示胰腺尾部存在胰岛素瘤。两例患者的胰岛素瘤部位均在手术中得到证实。病例1中腺瘤被摘除，病例2中通过胰腺尾部部分切除术将其切除。——这些观察结果表明，隐匿性胰岛素瘤可通过动脉内注射钙并同时测定肝静脉血中的胰岛素浓度在术前定位。
