Sakamoto Akimasa, Ogawa Kohei, Iwata Miku, Ito Chihiro, Shine Mikiya, Matsui Takashi, Nishi Yusuke, Uraoka Mio, Utsunomiya Takeshi, Nagaoka Tomoyuki, Tamura Kei, Funamizu Naotake, Inoue Hitoshi, Sakamoto Katsunori, Kurata Mie, Takada Yasutsugu
Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
Department of Pathology, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
J Surg Case Rep. 2022 Jul 30;2022(7):rjac249. doi: 10.1093/jscr/rjac249. eCollection 2022 Jul.
Proinsulinoma is a subtype of insulinoma that is surgically curable, but localization can be difficult as these tumors are typically too small to be visualized by imaging. We report the case of a 53-year-old woman referred to our hospital with dizziness and headache. Her blood glucose level was 46 mg/dl and Whipple's triad was present. Although her immunoreactive insulin level during hypoglycemia was in the normal range (5.0 μU/ml), the proinsulin level was elevated (408 pmol/l). Imaging examinations showed no evidence of pancreatic tumor. A preoperative selective arterial calcium injection (SACI) test showed excessive insulin secretion in the splenic artery region, which localized the proinsulinoma to the body or tail of the pancreas, and laparoscopic spleen-preserving distal pancreatectomy was performed. Intraoperative SACI test performed after tumor removal did not show excessive insulin secretion. The intraoperative SACI test appears to be useful for localization and for confirming complete resection of proinsulinoma.
胰岛素原瘤是胰岛素瘤的一种亚型，可通过手术治愈，但由于这些肿瘤通常太小，无法通过影像学检查发现，因此定位可能会很困难。我们报告了一例53岁女性因头晕和头痛转诊至我院的病例。她的血糖水平为46mg/dl，符合Whipple三联征。尽管她在低血糖期间的免疫反应性胰岛素水平在正常范围内（5.0μU/ml），但胰岛素原水平升高（408pmol/l）。影像学检查未发现胰腺肿瘤的证据。术前选择性动脉钙注射（SACI）试验显示脾动脉区域有过量胰岛素分泌，将胰岛素原瘤定位在胰腺体部或尾部，随后进行了保留脾脏的腹腔镜远端胰腺切除术。肿瘤切除后进行的术中SACI试验未显示过量胰岛素分泌。术中SACI试验似乎有助于胰岛素原瘤的定位和确认其完全切除。
