Philippe Lucien Pereira MD, Presenter: Nothing to Disclose

Jakub Wiskirchen MD, Abstract Co-Author: Nothing to Disclose

Dietrich Overkamp, Abstract Co-Author: Nothing to Disclose

Reinhard Teichmann, Abstract Co-Author: Nothing to Disclose

Norbert I. Stauder MD, Abstract Co-Author: Nothing to Disclose

Claus Detlef Claussen MD, Abstract Co-Author: Nothing to Disclose

Small pancreatic endocrine tumors often defy preoperative morphological investigations. Our aim was to evaluate the potential of intraarterial stimulation tests for the preoperative localization of small hormone secreting neoplasms.

We performed on 34 patients with either hyperinsulinism (n=28) or with hypergastrinemia (n=6). Besides morphological imaging with transabdominal, endoscopic sonography, computertomography, magnetic resonance imaging, and angiography, functional investigations with arterial stimulations and venous samplings were also carried out. Here, hormone concentrations were measured in hepatic venous blood after selective intraarterial stimulation with specific secretagogues, and transhepatic pancreatic venous samplings with measurement of hormonal concentrations into the peripancreatic veins.

A conclusive pathological hormone secretion was demonstrated by functional examinations with 26 patients. Twenty-four patients underwent surgery which confirmed the preoperative functional diagnosis in 22/22 hypoglycemic patients and in 2/3 patients with hypergastrinemia. The mean size of the adenomas at a cross section was 0.8cm for insulinomas, and 0.5cm for gastrinomas. The eight cases with inconclusive functional tests included malignant insulinomas (n=2), gastrinomas (n=3), one exogenous hyperinsulinism, and two non biochemically proven hyperinsulinisms. Results of functional examinations directly affected the surgical management of six patients.

Selective arterial stimulation, is less invasive than transhepatic peripancreatic venous samplings. Although it provides a high accuracy in the preoperative localization of benign insulinomas regardless of their size,it is however, less efficient in cases of malignant insulinomas, and in gastrinomas.

Pereira, P, Wiskirchen, J, Overkamp, D, Teichmann, R, Stauder, N, Claussen, C, Preoperative Localization of Small Islet Tumor Cells of the Pancreas: Is There a Need for Intraarterial Functional Investigations?.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4416912.html