A Case of Insulinoma Identified by Computed Tomography and Percutaneous Transhepatic Portal Vein Catheterization

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  • 腹部ＣＴスキャンと経皮経肝門脈カテーテル法により局在診断しえたインスリノーマの１例
  • フクブ CT スキャン ト ケイヒケイ カンモン ミャクカテーテルホウ ニ ヨ

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Abstract

A 50-year-old woman was admitted to hospital in May 1981 because of hypoglycemic episodes. Her fasting blood glucose, immunoreactive insulin and C-peptide immunoreactivity levels were 30-55mg/dl, 8-20μU/ml and 1.25-2.13ng/ml, respectively. Positive results were not obtainedby provocative tests on insulin secretion (glucose tolerance, tolbutamide, leucine, glucagon and calcium infusion tests).<BR>Angiography of the celiac and superior mesenteric arteries, endoscopic retrograde pancreatography and ultrasonic examination of the pancreas, failed to reveal any tumor. Computed tomography demonstrated a slightly dense lesion measuring 1 cm in diameter in the tail of the pancreas.<BR>The insulin levels in the portal and splenic venous blood obtained by percutaneous transhepatic catheterization showed a prominent peak (58μU/ml) in the splenic vein which suggested an insulinsecreting tumor in the tail. A tumor (1×1×0.7cm) was subsequently found in the tail of the pancreas at operation.<BR>This study indicates that computed tomography and percutaneous transhepatic portal vein catheterization can be important in the preoperative localization of insulinoma.

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