Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
Front Endocrinol (Lausanne). 2024 Oct 21;15:1305958. doi: 10.3389/fendo.2024.1305958. eCollection 2024.
Insulinomas are rare insulin-secreting neuroendocrine neoplasms of the pancreas. First-line treatment is the surgical removal of the tumor, however, the localization with standard imaging techniques is often challenging. With the help of selective intraarterial calcium stimulation the insulinoma's localization can be narrowed down to one third of the pancreas which the selected artery supplies.
We aimed to prove the usefulness of the calcium stimulation test in case of 9 patients treated between 2006 and 2021 diagnosed with endogenous hyperinsulinemic hypoglycemia confirmed by fasting test, where conventional imaging methods, like transabdominal ultrasound, CT or MRI failed to detect the source of hyperinsulinemia.
We performed selective intraarterial calcium stimulation with angiography with calcium gluconate injected to the main supporting arteries of the pancreas (splenic, superior mesenteric and gastroduodenal arteries); blood samples were obtained from the right hepatic vein before, and 30, 60 and 120 seconds after calcium administration.
With selective angiography we found a significant elevation of insulin levels taken from the right hepatic vein in five of the nine cases. On histopathology, the lesions were between 1-2 cm, in one case malignancy was also confirmed. In four patients we found a significant rise of insulin levels obtained from all catheterized sites, which confirmed the diagnosis of nesidioblastosis. In three cases no surgery was performed, and the symptoms relieved with medical treatment.
Selective intraarterial calcium stimulation remains an important tool in localization of the source of insulin excess, especially in cases where other diagnostic modalities fail.
胰岛素瘤是胰腺罕见的胰岛素分泌神经内分泌肿瘤。一线治疗方法是手术切除肿瘤，但标准影像学技术的定位往往具有挑战性。借助选择性动脉内钙刺激，胰岛素瘤的定位可以缩小到供应肿瘤的胰腺的三分之一。
我们旨在证明钙刺激试验在 9 例患者中的有用性，这些患者在 2006 年至 2021 年期间被诊断为内源性高胰岛素血症性低血糖症，该症通过禁食试验得到证实，而常规影像学方法，如经腹超声、CT 或 MRI 未能检测到高胰岛素血症的来源。
我们对胰腺的主要支持动脉（脾动脉、肠系膜上动脉和胃十二指肠动脉）进行了选择性动脉内钙刺激造影，用葡萄糖酸钙注射；在钙给药前、给药后 30、60 和 120 秒从右肝静脉采集血样。
在 9 例患者中，通过选择性血管造影，我们在 5 例患者中发现右肝静脉采集的胰岛素水平显著升高。在组织病理学上，病变大小在 1-2 厘米之间，在 1 例中还证实了恶性肿瘤。在 4 例患者中，我们从所有插管部位都发现了胰岛素水平的显著升高，这证实了神经内分泌细胞瘤的诊断。在 3 例患者中，未进行手术，症状通过药物治疗缓解。
选择性动脉内钙刺激仍然是定位胰岛素过多来源的重要工具，特别是在其他诊断方法失败的情况下。
