Diagnosis and Localization of Insulinoma after Negative Laparotomy by Hyperinsulinemic, Hypoglycemic Clamp and Intra-Aterial Calcium Stimulation

A 40-year-old woman with recurrent episodes of hypoglycemia was referred because of suspected insulinoma. Prolonged fasting was discontinued after 24 h due to symptomatic hypoglycemia (29 mg/dl, glucose/insulin-ratio 0.34). Magnetic resonance tomography showed a small 0.3 cm lesion in the body of the pancreas. During subsequent surgery a pancreatic tumor could not be detected, neither by manual palpation nor intraoperative ultrasonography. A hyperinsulinemic, sequentially eu- and hypoglycemic clamp confirmed the biochemical diagnosis of endogenous hyperinsulinemia and intra-arterial calcium stimulation localized calcium responsive tissue in the feeding distribution of the superior mesenteric artery. An octreotide scan was negative. During relaparotomy, six weeks after the initial surgery, the pancreatic body and tail were resected and a ∼1 cm non-malignant insulinoma was found. Although the use of highly sensitive, and more sophisticated and expensive methods for the diagnosis and localization of insulinomas are not generally suggested, we recommend application of intra-arterial calcium stimulation if the tumor is not detected using conventional diagnostic procedures

Early Assessment of Pancreatic Infections and Overall Prognosis in Severe Acute Pancreatitis by Procalcitonin (PCT): A Prospective International Multicenter Study

Early and reliable assessment of pancreatic infections is of major importance for timely goal-directed treatment in acute pancreatitis. The results of our prospective international multicenter study in patients with predicted severe disease has shown that a single laboratory test, Procalcitonin, significantly contributes to an early stratification of patients at risk to develop clinically relevant pancreatic infections or death