O'Shea D, Rohrer-Theurs A W, Lynn J A, Jackson J E, Bloom S R
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital London, United Kingdom.
J Clin Endocrinol Metab. 1996 Apr;81(4):1623-7. doi: 10.1210/jcem.81.4.8636378.
This study examines the role of selective intraarterial calcium injection and hepatic venous sampling in the localization of insulinomas. Seven patients were studied. In all cases, ultrasound and computerized tomography scans were either negative or equivocal. Calcium gluconate was injected directly into the arteries supplying the pancreas after standard selective angiography. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60, 90, 120, and 180 s after each injection. Two doses were used, 0.025 milliequivalents Ca/kg (1 mg/kg) for the first two subjects and 0.00625 milliequivalents Ca/kg (0.25 mg/kg) for the remaining five subjects. Serum insulin levels rose at least 2-fold, the proposed diagnostic rise, from basal in six subjects; one test was negative. Of the six positive studies, a diagnostic rise was seen only in one artery in five cases. One patient did not undergo surgery. In the remaining five patients, surgery confirmed the position and histology of the tumor. The one patient with a diagnostic rise in more than one artery, however, had residual disease after surgery. The seventh subject referred specifically for localization had a negative calcium stimulation study and a subsequent diagnosis of intermittent sulfonylurea abuse was made after a positive screen. The present study shows that preoperatively, selective intraarterial calcium injection with hepatic venous sampling is a powerful technique for the localization of insulinomas. Smaller doses of calcium than previously reported can be used and may reduce the risk of hypoglycemia during the procedure.
本研究探讨选择性动脉内注射钙剂及肝静脉采血在胰岛素瘤定位中的作用。共研究了7例患者。所有病例中，超声和计算机断层扫描结果均为阴性或不明确。在标准选择性血管造影后，将葡萄糖酸钙直接注入供应胰腺的动脉。在每次注射前及注射后30、60、90、120和180秒，从右肝静脉采集样本测量胰岛素水平。使用了两种剂量，前两名受试者为0.025毫当量钙/千克（1毫克/千克），其余五名受试者为0.00625毫当量钙/千克（0.25毫克/千克）。6名受试者的血清胰岛素水平从基础值至少升高了2倍，即达到了诊断性升高；1次检测为阴性。在6项阳性研究中，5例仅在1条动脉中出现诊断性升高。1例患者未接受手术。在其余5例患者中，手术证实了肿瘤的位置和组织学。然而，在不止1条动脉中出现诊断性升高的1例患者术后有残留病灶。第7例专门因定位问题转诊的受试者钙剂刺激试验为阴性，在筛查呈阳性后随后诊断为间歇性磺脲类药物滥用。本研究表明，术前选择性动脉内注射钙剂及肝静脉采血是胰岛素瘤定位的有效技术。可使用比先前报道更小剂量的钙剂，这可能会降低手术过程中低血糖的风险。
