Exp Clin Endocrinol Diabetes 2005; 113(8): 471-474
DOI: 10.1055/s-2005-865752
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Ultrasound Imaging of Insulinomas: Limitations and Clinical Relevance

P. H. Kann1 , M. Rothmund2 , A. Zielke2
  • 1Division of Endocrinology & Diabetology, Philipp's University Hospital, Marburg, Germany
  • 2Department of Surgery, Philipp's University Hospital, Marburg, Germany
Further Information

Publication History

Received: March 16, 2005 First decision: April 18, 2005

Accepted: May 23, 2005

Publication Date:
08 September 2005 (online)

Abstract

Compared to other imaging methods, endoscopic ultrasound is the best procedure to localize insulinomas preoperatively. Positive finding furthermore confirms endocrinological diagnosis, especially considering the differential diagnosis of hypoglycaemia factitia by oral antidiabetics. However, it always has to be considered that endoscopic ultrasound imaging may reveal false positive and false negative results, and quality of the findings obtained by endoscopic ultrasound imaging depends to a large extent on the examiner's experience. An important issue of endoscopic ultrasound imaging in insulinomas nowadays is planning surgical strategy. As illustrated by three cases, endoscopic ultrasound imaging enables to identify patients that qualify for laparoscopic, minimal invasive surgery.

References

  • 1 Ardengh J C, Rosenbaum P, Ganc A J, Goldenberg A, Lobo E J, Malheiros C A, Rahal F, Ferrari A P. Role of EUS in the preoperative localization of insulinomas compared with spiral CT.  Gastrointest Endosc. 2000;  51 552-555
  • 2 Besim H, Korkmaz A, Hamamcy O, Karaahmetoglu S. Review of eight cases of insulinoma.  East Afr Med J. 2002;  79 368-372
  • 4 Fendrich V, Bartsch D K, Langer P, Zielke A, Rothmund M. Diagnosis and surgical treatment of insulinoma - experiences in 40 cases.  Dtsch Med Wochenschr. 2004;  129 941-946
  • 5 Hirshberg B, Livi A, Bartlett D L, Libutti S K, Alexander H R, Doppman J L, Skarulis M C, Gorden P. Forty-eight-hour fast: the diagnostic test for insulinoma.  J Clin Endocrinol Metab. 2000;  85 3222-3226
  • 6 Kann P, Bittinger F, Engelbach M, Bohner S, Weis A, Beyer J. Endosonography of insulin-secreting and clinically non-functioning neuroendocrine tumours of the pancreas: criteria for benignancy and malignancy.  Eur J Med Res. 2001;  6 385-390
  • 7 Kann P H, Wirkus B, Keth A, Goitom K. Pitfalls in endosonographic imaging of suspected insulinomas: pancreatic nodules of unknown dignity.  Eur J Endocrinol. 2003;  148 531-534
  • 8 Kann P H. Endoscopic ultrasound imaging of the adrenals.  Endoscopy. 2005;  37 244-253
  • 9 Langer P, Kann P H, Fendrich V, Richter G, Diehl S, Rothmund M, Bartsch D K. Prospective evaluation of imaging procedures for the detection of pancreaticoduodenal endocrine tumours in patients with multiple endocrine neoplasia type 1.  World J Surg. 2004;  28 1317-1322
  • 11 Mirallie E, Pattou F, Malvaux P, Filoche B, Godchaux J M, Maunoury V, Palazzo L, Lefebvre J, Huglo D, Paris J C, Carnaille B, Proye C. Value of endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localization of insulinomas and gastrinomas. Experience of 54 cases.  Gastroenterol Clin Biol. 2002;  26 360-366
  • 12 Nesje L B, Varhaug J E, Husebye E S, Odegaard S. Endoscopic ultrasonography for preoperative diagnosis and localization of insulinomas.  Scand J Gastroenterol. 2002;  37 732-737
  • 13 Zimmer T, Scherubl H, Faiss S, Stolzel U, Riecken E O, Wiedenmann B. Endoscopic ultrasonography of neuroendocrine tumours.  Digestion. 2000;  62 (Suppl 1) 45-50

M.D. Peter Herbert Kann Professor of Endocrinology, Head

Division of Endocrinology & Diabetology
Philipp's University Hospital

Baldinger Straße

35033 Marburg

Germany

Email: kannp@med.uni-marburg.de

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