Accurate localization of insulinoma using percutaneous transhepatic portal venous sampling--usefulness of simultaneous measurement of plasma insulin and glucagon levels.

By means of percutaneous transhepatic portal venous sampling (PTVS), plasma insulin and glucagon levels were determined simultaneously at various sites of the hepatic portal venous system in two patients with insulinoma and four patients without. In the two cases of insulinoma, an obvious rise of insulin concentration was observed at the vicinity of the tumour, while glucagon levels were not elevated in the blood samples showing an insulin peak. In the remaining four cases without evidence of insulinoma, significant step-ups of plasma insulin occurred in the splenic vein as well, but were accompanied with concomitant elevation of plasma glucagon levels in the same blood samples. Thus, by measuring insulin alone, false positive data may frequently be obtained when PTVS is performed on patients with suspected insulinomas. The simultaneous measurement of insulin and glucagon might be helpful in avoiding such errors.