Glucose-responsive Insulinoma Diagnosed Using Somatostatin Receptor Scintigraphy and Intraoperative Intravenous Glucose Tolerance Test—A Case Report—

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  • OKURA Ryosuke
    Department of General Surgery, Chiba University, Graduate School of Medicine
  • YOSHITOMI Hideyuki
    Department of General Surgery, Chiba University, Graduate School of Medicine
  • TAKAYASHIKI Tsukasa
    Department of General Surgery, Chiba University, Graduate School of Medicine
  • FURUKAWA Katsunori
    Department of General Surgery, Chiba University, Graduate School of Medicine
  • KUBOKI Satoshi
    Department of General Surgery, Chiba University, Graduate School of Medicine
  • OHTSUKA Masayuki
    Department of General Surgery, Chiba University, Graduate School of Medicine

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Other Title
  • 術前術中の診断に苦慮した糖反応性低血糖を示すインスリノーマの1例
  • 症例 術前術中の診断に苦慮した糖反応性低血糖を示すインスリノーマの1例
  • ショウレイ ジュツゼン ジュッチュウ ノ シンダン ニ クリョ シタ トウ ハンノウセイ テイケットウ オ シメス インスリノーマ ノ 1レイ

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Description

A 79-year-old man who had previously undergone surgical resection twice for his pancreatic insulinoma presented with postprandial hypoglycemia. Although recurrence of insulinoma was suspected, fasting blood glucose, immunoreactive insulin (IRI), and Fajan's index were within the normal range. The 75 g oral glucose tolerance test revealed excessive insulin secretion and hypoglycemia only after glucose loading. Dynamic contrast-enhanced computed tomography showed a solitary tumor in the stump of the pancreatic tail (20 mm), and a suspected metastatic nodule at the head (13 mm). Somatostatin receptor scintigraphy also showed abnormal accumulation at this site. Pathological analysis of the pancreatic tumor using endoscopic ultrasonography guided fine-needle aspiration biopsy revealed recurrence of insulinoma. Pancreatic body/tail resection and lymph node dissection were performed. To confirm complete resection of multiple lesions, intraoperative intravenous glucose tolerance test was performed. Before resection, glucose loading resulted in a markedly increased IRI level of up to 410 μIU/ml and severe hypoglycemia. After resection, the IRI level was slightly increased, and hypoglycemia was not observed, which confirmed complete resection. Therefore, the intraoperative glucose loading test can be used to confirm complete resection of glucose-responsive insulinoma.

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