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Accession number;01A0793355
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| Title;A Case of Insulinoma with Normoinsulinemia and Hyperproinsulinemia. |
| Author;
NAKAMARU KAZUHIKO
(Oitakenbyoin Daiichinaika)
HASHIGUCHI YASUHIRO
(Oitakenbyoin Daiichinaika)
SUMI HIROKUNI
(Oitakenbyoin Daiichinaika)
ETO TAKESHI
(Oitakenbyoin Daiichinaika)
YOSHIMURA AKIRA
(Oitakenbyoin Daiichinaika)
YAMAGUCHI YASUHIRA
(Oitakenbyoin Daiichinaika)
NAMBARA SHIGERU
(Oitakenbyoin Geka)
UEO HIROAKI
(Oitakenbyoin Geka)
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Journal Title;Journal of the Japan Diabetic Society
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Journal Code:Z0279B
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ISSN:0021-437X
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VOL.44;NO.7;PAGE.563-568(2001)
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| Figure&Table&Reference;FIG.1, TBL.2, REF.22 |
| Pub. Country;Japan |
| Language;Japanese |
| Abstract;A 31-year-old man with inpaired consciousness and urinary and fecal incontinence was admitted to hospital. Based on his low blood glucose (BG) levels (29 mg/dl), he was diagnosed as being in a hypoglycemic coma. The patient recovered after receiving an intravenous infusion of glucose. Although insulinoma was suspected as a cause of the hypoglycemia, hyperinsulinemia was never demonstrated. In other words, the patient's immunoreactive insulin (IRI) levels were always lower than 10 .MU.U/ml, and his IRI/BG ratio was never higher than 0.5. However, the patient's plasma proinsulin levels were markedly elevated at 89.3 pmol/L (the normal range is 2.9-13.1 pmol/L). An intra-arterial calcium infusion was performed to determine if a pancreatic islet cell tumor was present. The calcium was infused into the celiac artery, and a sample was taken through the portal vein by percutaneous transhepatic portal catheterization. During this test, a marked rise in IRI levels was observed at the confluent point of the portal-splenic vein. Moreover, a selective celiac angiography revealed a tumor stain at the pancreatic uncus. The patient was diagnosed as having insulinoma, and surgery was performed to enucleate the tumor. After surgery, the patient's plasma proinsulin levels fell to a normal value of 6.4 pmol/L and the hypoglycemic symptoms disappeared. The low IRl and high proinsulin levels observed this case are relatively rare among cases of insulinomas. Intra-arterial calcium infusion with venous sampling can be a useful procedure for the detection of insulinoma. (author abst.) |
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