Nakagawa Atsushi, Ueno Keiichi, Ito Masatsune, Okamoto Shinya, Uehara Keigo, Ito Hiroki, Mishina Suguru, Kinoshita Eriko, Nojima Takayuki, Takahashi Hiroaki, Ikawa Hiromichi, Takashima Shigeki, Nishizawa Makoto, Nakano Shigeru, Kigoshi Toshikazu, Nakabayashi Hajime, Uchida Kenzo
Department of Endocrinology, Kanazawa Medical University, Uchinada, Japan.
Endocr J. 2007 Feb;54(1):27-33. doi: 10.1507/endocrj.k06-104. Epub 2006 Oct 20.
Selective arterial calcium stimulation and hepatic venous sampling (ASVS) for insulin secretion is used as a diagnostic procedure in patients with insulinomas or adult nesidioblastosis. In some of those patients, severe hypoglycemia requiring urgent glucose administration occurs during the procedure. Such glucose administration, however, may affect the results and damage the validity of the test. We report two cases of hyperinsulinemic hypoglycemia, in which ASVS tests were successfully performed under hyperinsulinemic euglycemic glucose clamps. A 40-year-old male with nesidioblastosis developed continual severe hypoglycemia several years after a Billroth II-Braun gastrectomy, and continuous glucose infusion could not be stopped even during ASVS tests. A 9-year-old girl with an insulinoma that showed atypical hypovascularity on imaging examinations had ASVS tests under a glucose clamp for safety. Hyperinsulinemic (approximately 100 microU/ml) euglycemic (approximately 90 mg/dl) clamps were achieved by an artificial endocrine pancreas. The insulin analogue lispro was utilized for clamps and endogenous insulin was measured with an assay that does not cross-react with the analogue. Diagnostically significant responses (more than twofold) of insulin secretion were observed under hyperinsulinemic clamps in both cases. The use of the hyperinsulinemic glucose clamp technique during the ASVS test should be considered for maintaining the safety of some hypoglycemic patients.
选择性动脉钙刺激和肝静脉采血（ASVS）用于胰岛素分泌，是胰岛素瘤或成人胰岛细胞增殖症患者的诊断方法。在部分此类患者中，检查过程中会出现需要紧急输注葡萄糖的严重低血糖。然而，这种葡萄糖输注可能会影响结果并损害检查的有效性。我们报告了两例高胰岛素血症性低血糖病例，其中在高胰岛素正常血糖葡萄糖钳夹下成功进行了ASVS检查。一名患有胰岛细胞增殖症的40岁男性在毕Ⅱ式- Braun胃切除术后数年出现持续性严重低血糖，即使在ASVS检查期间也无法停止持续葡萄糖输注。一名9岁女孩患有胰岛素瘤，影像学检查显示非典型血管减少，为安全起见在葡萄糖钳夹下进行了ASVS检查。通过人工内分泌胰腺实现了高胰岛素（约100微单位/毫升）正常血糖（约90毫克/分升）钳夹。胰岛素类似物赖脯胰岛素用于钳夹，内源性胰岛素通过与该类似物无交叉反应的检测方法进行测定。在两例病例的高胰岛素钳夹下均观察到具有诊断意义的胰岛素分泌反应（超过两倍）。对于一些低血糖患者，在ASVS检查期间应考虑使用高胰岛素葡萄糖钳夹技术以确保安全。
