National Cancer Institute®
Last Modified: March 1, 2002
UI - 11779995
AU - Solivetti FM; Giunta S; Caterino M; De Majo A; Coscarella G; Carducci M
TI - [CT findings in a case of glucagonoma with necrolytic migrating erythema]
SO - Radiol Med (Torino) 2001 Nov-Dec;102(5-6):410-2
AD - Servizio di Radiologia,IRCCS Istituto Dermosifilopatico di Santa Maria e San Gallicano, IFO, Rome, Italy.
UI - 11808217
AU - Tsuzuki Y; Ishii H
TI - [Insulinoma--a statistical review of 358 cases of insulinoma reported from 1991 to 2000 in Japan]
SO - Nippon Rinsho 2001 Dec;59 Suppl 8():121-31
AD - Department of Internal Medicine II, National Defense Medical College.
UI - 11740056
AU - Lam K; Lo C; Wat M; Fan ST
TI - Malignant insulinoma with hepatoid differentiation: a unique case with alpha-fetoprotein production.
SO - Endocr Pathol 2001 Fall;12(3):351-4
AD - Department of Pathology, University of Hong Kong Medical Center, Queen Mary Hospital. firstname.lastname@example.org
Hepatoid carcinomas are uncommon extra-hepatic neoplasms exhibiting features of hepatocellular carcinoma and they are most frequently described in the stomach. We report a 64-year-old woman with a malignant insulinoma showing focal hepatoid differentiation and biochemical evidence of alpha-fetoprotein (AFP) production. The current case is the first malignant insulinoma with hepatoid differentiation. Resection of the primary tumor followed by regional embolization was peformed. The patient died 22 months after initial presentation. Thus, the presence of hepatoid differentiation in pancreatic tumor should be noted as the tumor may be associated with elevated AFP. The features of pancreatic hepatoid carcinomas are discussed.
UI - 11589679
AU - Brandle M; Pfammatter T; Spinas GA; Lehmann R; Schmid C
TI - Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours.
SO - Clin Endocrinol (Oxf) 2001 Sep;55(3):357-62
AD - Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Zurich, Switzerland. email@example.com
OBJECTIVE: Non-invasive localization modalities such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) often fail to localize insulinomas smaller than 2 cm in diameter. Recent studies have shown that the selective arterial stimulation and hepatic venous sampling (ASVS) technique using intra-arterial calcium as the insulin secretagogue facilitates the regionalization of such occult insulinomas. This study assesses the sensitivity of ASVS in localizing insulin-secreting tumours. SUBJECTS AND METHODS: Eleven consecutive patients (8 women), aged 29-82 years, were studied over the past 4 years at our hospital. Hyperinsulinaemic hypoglycaemia due to an insulin-secreting tumour was proven in all patients. Calcium gluconate (0.025 mEq/kg body weight) was injected directly into the arteries supplying the pancreas and the liver. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60 and 120 s after each injection. The ASVS technique was performed in all 11 patients; the results were compared with the surgical findings in 10 patients and the autopsy findings in 1 case. The ASVS results were also compared with the findings of other, previously performed imaging modalities. RESULTS: ASVS correctly localized 4 insulin-secreting tumours to the head, 3 to the body, 1 to the tail, 2 to the tail or body of the pancreas and 1 to the liver. Thus, the sensitivity was 100% (11/11) whereas other localization techniques were less sensitive: 7/11 tumours were detected by angiography, 4/8 by endosonography, 3/8 by CT and 1/6 by MRI. Insulinomas (confirmed by histological examination), sized 4-25 mm, were found in 10 patients. All were cured by selective surgery and remained free of hypoglycaemia over the next 1-4 years of follow-up. An insulin-secreting neuroendocrine tumour in the liver was documented in 1 case at autopsy. CONCLUSIONS: Arterial stimulation and hepatic venous sampling is a very sensitive technique for preoperative localization of insulin-producing tumours. It can help to plan minimally invasive surgery and to select an appropriate strategy for patients suffering from malignant tumours in others.
UI - 11874403
AU - Matson MB; Reznek RH
TI - Assessment of selective arterial calcium stimulating and hepatic venous sampling to localize insulin-secreting tumours.
SO - Clin Endocrinol (Oxf) 2002 Feb;56(2):149-50
AD - Barts and The London NHS Trust, UK.
UI - 11859446
AU - Meier JJ; Hucking K; Gruneklee D; Schmiegel W; Nauck MA
TI - [Differences in insulin secretion facilitate the differential diagnosis of insulinoma and factitious hypoglycaemia]
SO - Dtsch Med Wochenschr 2002 Feb 22;127(8):375-8
AD - Medizinische Universitatsklinik, Knappschaftskrankenhaus, Bochum, Germany.
HISTORY: A 33-year-old female nurse (married; two children; BMI 30.9 kg/m2) had recurrent episodes of symptomatic hypoglycaemia over some months. INVESTIGATIONS: Two fasting tests were terminated after 26 hours because the patient became unconscious. Improved insulin/glucose ratio was infinity and 6.1 [mU/l]/[mg/dl] (normal value < 0.5). An hyperinsulinaemic-hypoglycaemic angle "clamp test" produced a C-peptide suppression to minimally 0.26 - 0.38 nmol/l (normal value 0.06 +/- 0.01 nmol). There was no spontaneous or paradoxical burst in insulin or C-peptide concentration after either the fasting or the "clamp test". Serum analysis of sulphonylurea on several occasions documented an increase of glibenclamide above therapeutic range. TREATMENT AND COURSE: The patient denied any intake of oral antidiabetic preparations, but there were no further hypoglycaemia attacks in subsequent months. DIAGNOSIS: The demonstration of sulphonylurea in serum confirmed the diagnosis of factitious hypoglycaemia. CONCLUSION: With regard to insulin or C-peptide suppression, the results of the fasting and clamp tests are the same in factitious hypoglycaemia and insulinoma. However, under the influence of sulphonylurea drugs there are no insulin or C-peptide bursts so typical of insulinoma. In case of doubt, detection of sulphonylurea preparations in serum or urine is the only reliable way of diagnosing factitious hypoglaema due to the ingestion of sulphonylurea.
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