Endocrine Abstracts

Objective: The aim of this study was to assess the utility of arterial calcium stimulation with hepatic venous sampling (ASVS) in the localization of tumors in patients with endogenous hyperinsulinism not detected with other methods.

Patients and methods: We performed a retrospective study of 30 patients admitted to our hospital for hypoglycemia who underwent ASVS because the source of hyperinsulinism was not clearly identified by other imaging techniques. The histopathological results in patients who underwent a surgical procedure were considered the reference for statistical study of the accuracy of this technique. Statistical analysis was performed by comparing proportions with the χ² test with Yates’ correction for contingency tables, and Cohen’s κ coefficient as a measure of interrater agreement between two observations.

Results: Surgery was performed in 21 patients, 20 with positive ASVS and the remaining one with negative result. Endogenous hyperinsulinism (insulinoma and nesidioblastosis) was removed in 19 patients, and all of these were detected in the ASVS. A total of 95% of the positive ASVS test were diagnosed of endogenous hyperinsulinism (80% insulinoma and 15% nesidioblastosis), and 100% of endogenous hyperinsulinism had a positive result of the ASVS being this association statistically significant (χ²=15.771; P<0.001). A good and statistically significant agreement was obtained between histopathologic diagnostic and ASVS results. (K=0.518, P<0.001).

Conclusions: ASVS is a useful procedure in the localization diagnosis of endogenous hyperinsulinism not detected by other imaging tests. This technique allows tumors in the pancreatic gland to be identified and may be useful in the choice of the surgical technique to be used.