Display options
Cite
Subasinghe D, Gunatilake SSC, Dassanyake VE, et al. Seeking the unseen: Localization and surgery for an occult sporadic insulinoma. Ann Hepatobiliary Pancreat Surg. 2020;24(2):234-238doi: 10.14701/ahbps.2020.24.2.234.
Subasinghe, D., Gunatilake, S. S. C., Dassanyake, V. E., Garusinghe, C., Ganewaththa, E., Appuhamy, C., Somasundaram, N. P., & Sivaganesh, S. (2020). Seeking the unseen: Localization and surgery for an occult sporadic insulinoma. Annals of hepato-biliary-pancreatic surgery, 24(2), 234-238. https://doi.org/10.14701/ahbps.2020.24.2.234
Subasinghe, Duminda, et al. "Seeking the unseen: Localization and surgery for an occult sporadic insulinoma." Annals of hepato-biliary-pancreatic surgery vol. 24,2 (2020): 234-238. doi: https://doi.org/10.14701/ahbps.2020.24.2.234
Subasinghe D, Gunatilake SSC, Dassanyake VE, Garusinghe C, Ganewaththa E, Appuhamy C, Somasundaram NP, Sivaganesh S. Seeking the unseen: Localization and surgery for an occult sporadic insulinoma. Ann Hepatobiliary Pancreat Surg. 2020 May 31;24(2):234-238. doi: 10.14701/ahbps.2020.24.2.234. PMID: 32457273; PMCID: PMC7271113.
Copy Download .nbib Format: NLM
Share it on

Ann Hepatobiliary Pancreat Surg. 2020 May 31;24(2):234-238. doi: 10.14701/ahbps.2020.24.2.234.

Seeking the unseen: Localization and surgery for an occult sporadic insulinoma.

Annals of hepato-biliary-pancreatic surgery

Duminda Subasinghe, Sonali Sihindi Chapa Gunatilake, Vihara Erangika Dassanyake, Chaminda Garusinghe, Eranga Ganewaththa, Chinthaka Appuhamy, Noel P Somasundaram, Sivasuriya Sivaganesh

Affiliations

  1. Division of HPB Surgery, Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
  2. The University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
  3. Department of Endocrinology and Diabetes, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
  4. Department of Interventional Radiology, The National Hospital of Sri Lanka, Colombo, Sri Lanka.

PMID: 32457273 PMCID: PMC7271113 DOI: 10.14701/ahbps.2020.24.2.234

Abstract

Insulinomas are rare pancreatic neuroendocrine tumours and the commonest cause for endogenous hyperinsulinaemic hypoglycemia. Small tumours are not easily detected by conventional cross-sectional imaging making localization prior to surgical removal a challenge. Selective arterial calcium stimulation is an invaluable adjunct to localization in such circumstances. This is further supplemented by intraoperative ultrasonography. A 39-year-old male was referred with features of Whipple's triad of 10 months duration. Clinical and biochemical evaluation including C-peptide and serum insulin levels during supervised hypoglycemia concluded endogenous hyperinsulinaemia as the underlying aetiology. Contrast CT and MRI of the abdomen failed to localize the tumour. Selective arterial calcium stimulation localized the lesion in distal pancreas. During the surgery, tumour was further localized to the tail of the pancreas using intraoperative ultrasonography and enucleated. Histology confirmed an insulinoma and patient made an unremarkable recovery and was well more than a year after the surgery.

Keywords: Enucleation; Insulinoma; Selective arterial calcium stimulation

References

  1. World J Gastroenterol. 2008 Feb 7;14(5):657-65 - PubMed
  2. Clin Radiol. 2005 Oct;60(10):1039-50 - PubMed
  3. Ann Intern Med. 1995 Aug 15;123(4):269-73 - PubMed
  4. Clin Endocrinol (Oxf). 2001 Sep;55(3):357-62 - PubMed
  5. Gastrointest Endosc. 2000 May;51(5):552-5 - PubMed
  6. Mayo Clin Proc. 1991 Jul;66(7):711-9 - PubMed
  7. J Clin Endocrinol Metab. 2009 Apr;94(4):1074-80 - PubMed
  8. Pancreas. 2014 Jul;43(5):675-86 - PubMed
  9. J Clin Endocrinol Metab. 2009 Apr;94(4):1069-73 - PubMed
  10. Endoscopy. 1996 Mar;28(3):273-6 - PubMed
  11. Ann Surg. 2008 Mar;247(3):490-500 - PubMed
  12. Radiology. 1991 Jan;178(1):237-41 - PubMed
  13. Surgery. 2015 Jul;158(1):162-72 - PubMed
  14. World J Surg. 1993 Jul-Aug;17(4):439-43 - PubMed
  15. Endocrine. 2007 Jun;31(3):238-41 - PubMed
  16. Future Oncol. 2010 Feb;6(2):229-37 - PubMed

Publication Types