Hall R S, Hanley J F, Georgitis W, McNally P R
Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045, USA.
Mil Med. 1998 Dec;163(12):853-6.
A 23-year-old male was referred to our hospital for evaluation of new-onset seizures. Signs and symptoms of neuroglycopenia, including weakness, dizziness, and confusion, appeared during fasting and resolved promptly with intravenous dextrose administration. Insulin, proinsulin, and C-peptide levels were consistent with a diagnosis of insulinoma. Screening tests for multiple endocrine neoplasia type 1 and surreptitious sulfonylurea uses were negative. Preoperative localization of the insulinoma by transabdominal ultrasonography, computed tomography, and indium-111 octreoscanning were unsuccessful. Endoscopic ultrasonography (EUS) identified a 6- to 7-mm tumor at the juncture of the head and body of the pancreas. Surgical exploration confirmed the preoperative localization, and an 8-mm tumor was simply enucleated. The patient has been free of symptoms for 18 months since surgery. This report describes the utility of EUS to localize a solitary pancreatic insulinoma and provides a comparison of EUS and other preoperative localization techniques.
一名23岁男性因新发癫痫发作被转诊至我院。禁食期间出现神经低血糖的体征和症状，包括虚弱、头晕和意识模糊，静脉输注葡萄糖后症状迅速缓解。胰岛素、胰岛素原和C肽水平与胰岛素瘤的诊断相符。多发性内分泌肿瘤1型和隐匿性磺脲类药物使用的筛查试验均为阴性。通过经腹超声、计算机断层扫描和铟-111奥曲肽扫描对胰岛素瘤进行术前定位均未成功。内镜超声（EUS）在胰头和胰体交界处发现一个6至7毫米的肿瘤。手术探查证实了术前定位，一个8毫米的肿瘤被简单摘除。自手术以来，患者已18个月无症状。本报告描述了EUS在定位孤立性胰腺胰岛素瘤方面的效用，并对EUS和其他术前定位技术进行了比较。
