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Intraoperative gamma probe detection of insulinoma in an elderly patient with pancreatic cystic lesions
Author(s) -
Rosière Alain,
Ernst Yves J.,
Roelants Véronique,
Vander Borght Thierry,
Michel Luc,
Donckier Julian E.
Publication year - 2002
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1046/j.1365-2265.2002.01646.x
Subject(s) - insulinoma , medicine , octreotide , magnetic resonance imaging , radiology , scintigraphy , pancreas , pancreatic disease , palpation , insulin , nuclear medicine , somatostatin
Summary Insulinoma is a rare endocrine tumour in the elderly. We report the case of an 81‐year‐old woman suffering from grand mal seizures. Insulinoma was suspected because plasma glucose and insulin levels were 1·5 mmol/l and 80·4 pmol/l, respectively. A pancreatic computerized tomography (CT) scan, magnetic resonance imaging (MRI) and arteriography were normal but 111 In‐DTPA‐octreotide scintigraphy detected a hotspot in the pancreatic tail. Intraoperative pancreatic ultrasonography and palpation were non‐contributory due to multiple pancreatic cysts and nodular lesions. However, a gamma‐detecting probe localized a small tumour, labelled preoperatively with 111 In‐DTPA‐octreotide. Intraoperative insulin measurements in portal venous blood confirmed the successful removal of an insulinoma that was 6 mm in diameter histologically. Pancreatic cystic lesions increase with age and make the intraoperative localization of the insulinoma difficult. Intraoperative gamma probe detection of the tumour labelled with 111 In‐DTPA‐octreotide might therefore constitute a useful surgical tool.