LOCALIZATION OF INSULINOMAS AND ISLET CELL HYPERPLASIAS BY PANCREATIC VEIN CATHETERIZATION AND INSULIN ASSAY

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  • 1 January 1978
    • journal article
    • research article
    • Vol. 146  (5) , 725-734
Abstract
Percutaneous transhepatic portal vein catheterization and transfemoral portal and caval catheterizations were performed under local anesthesia in 5 patients with symptoms of organic hypoglycemia. During the investigation, results of pancreatic phlebography revealed the pancreatic venous anatomy. Blood obtained from the celiac artery, caval branches and pancreatic veins was assayed for insulin by 2 radioimmunoassay methods. Pathologically high, pancreatic arteriovenous insulin differences were noted with both radioimmunoassay techniques in 2 patients with insulinomas and 2 patients with islet cell hyperplasia. In 1 of the patients with an insulinoma, 1 of the assays failed to detect tumor insulin. This inconsistency still remains unexplained. Angiography revealed a pancreatic abnormality in only 2 patients. During operation, 2 of the tumors were found on palpation and inspection. Pancreatic resections were performed according to the findings of pathologic hormone differences in all 5 patients. Immunocytochemistry revealed that 3 of the patients had insulin-producing tumors and 2 had local islet cell hyperplasia. Catheterizations performed 2 mo. postoperatively confirmed the radicality of the operation in all patients, with the possible exception of 1 patient. In 1 patient, a recurrence was detected by catheterization 10 mo. postoperatively.