Rapid intraoperative insulin assay: a novel method to differentiate insulinoma from nesidioblastosis in the pediatric patient.

Vivian E Strong, Alexander Shifrin, William B Inabnet
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引用次数: 7

Abstract

Introduction: Hyperinsulinism is the most common cause of recurrent and persistent hypoglycemia in infancy and childhood. Causes can include nesidioblastosis, pancreatic islet cell tumors such as insulinoma, and associations with multiple endocrine neoplasia syndromes. Although new, improved imaging techniques have allowed for more precise preoperative localization of insulinomas, the differentiation of nesidioblastosis and insulinoma, particularly in children, can be challenging. To improve intraoperative localization and confirmation of successful resection of insulinoma, a novel hormonal assay, the rapid intraoperative insulin assay, is reported for the first time in a pediatric patient. This intraoperative radioimmunoassay for insulin yields results within several minutes and confirms complete resection of insulinoma.

Case description: We present a case of pancreatic insulinoma in a child with symptoms of severe hypoglycemia, causing seizures. The insulinoma was enucleated laparoscopically, and rapid intra-operative insulin assay used to determine the success of the procedure.

Discussion and evaluation: This rapid intra-operative test provides a valuable adjunct for determining complete excision in complicated cases of recurrent or questionable insulinoma. Although not a common problem, for pediatric patients in whom the diagnosis is not clear, this test may provide a novel approach to confirming disease.

Conclusion: We propose the use of this assay in facilitating intra-operative resection and confirmation of complete excision in pediatric patients. This population may especially benefit from this novel assay to confirm complete resection and to differentiate multiple etiologies of hyperinsulinism.

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快速术中胰岛素测定:一种区分儿科患者胰岛素瘤和成肾细胞病的新方法。
导语:高胰岛素血症是婴儿期和儿童期反复和持续性低血糖的最常见原因。病因可包括nesidioblastosis,胰岛细胞肿瘤如胰岛素瘤,以及与多种内分泌肿瘤综合征相关。虽然新的、改进的成像技术已经允许更精确的胰岛素瘤术前定位,但胰腺母细胞病和胰岛素瘤的鉴别,特别是在儿童中,可能具有挑战性。为了提高术中胰岛素瘤的定位和成功切除的确认,一种新的激素测定,快速术中胰岛素测定,首次在儿科患者中报道。术中胰岛素放射免疫测定在几分钟内产生结果,并确认胰岛素瘤完全切除。病例描述:我们报告一例儿童胰腺胰岛素瘤,伴有严重低血糖,引起癫痫发作。腹腔镜下切除胰岛素瘤,快速术中胰岛素测定用于确定手术的成功。讨论和评价:这种快速的术中试验为确定复发或可疑的复杂胰岛素瘤的完全切除提供了有价值的辅助手段。虽然不是常见问题,但对于诊断不明确的儿科患者,该测试可能提供一种确认疾病的新方法。结论:我们建议在儿科患者术中使用这种检测方法,以方便术中切除和确认完全切除。这一人群可能特别受益于这种新的检测,以确认完全切除和区分多种病因的高胰岛素血症。
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