Insulin Responses to Selective Arterial Calcium Infusion under Hyperinsulinemic Euglycemic Glucose Clamps: Case Studies in Adult Nesidioblastosis and Childhood Insulinoma
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- NAKAGAWA Atsushi
- Department of Endocrinology, Kanazawa Medical University
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- UENO Keiichi
- Department of General and Gastrointestinal Surgery, Kanazawa Medical University
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- ITO Masatsune
- Department of Pediatrics, Kanazawa Medical University
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- OKAMOTO Shinya
- Department of Pediatric Surgery, Kanazawa Medical University
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- UEHARA Keigo
- Department of Endocrinology, Kanazawa Medical University
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- ITO Hiroki
- Department of Endocrinology, Kanazawa Medical University
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- MISHINA Suguru
- Medical Equipment Unit, Nikkiso Co., Ltd.
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- KINOSHITA Eriko
- Department of Pathology, Kanazawa Medical University
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- NOJIMA Takayuki
- Department of Pathology, Kanazawa Medical University
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- TAKAHASHI Hiroaki
- Department of Pediatrics, Kanazawa Medical University
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- IKAWA Hiromichi
- Department of Pediatric Surgery, Kanazawa Medical University
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- TAKASHIMA Shigeki
- Department of General and Gastrointestinal Surgery, Kanazawa Medical University
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- NISHIZAWA Makoto
- Department of Endocrinology, Kanazawa Medical University
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- NAKANO Shigeru
- Department of Endocrinology, Kanazawa Medical University
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- KIGOSHI Toshikazu
- Department of Endocrinology, Kanazawa Medical University
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- NAKABAYASHI Hajime
- Division of Life Science, Graduate School of Natural Science and Technology and Health Science Center, Kanazawa University
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- UCHIDA Kenzo
- Department of Endocrinology, Kanazawa Medical University
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Abstract
Selective arterial calcium stimulation and hepatic venous sampling (ASVS) for insulin secretion is used as a diagnostic procedure in patients with insulinomas or adult nesidioblastosis. In some of those patients, severe hypoglycemia requiring urgent glucose administration occurs during the procedure. Such glucose administration, however, may affect the results and damage the validity of the test. We report two cases of hyperinsulinemic hypoglycemia, in which ASVS tests were successfully performed under hyperinsulinemic euglycemic glucose clamps. A 40-year-old male with nesidioblastosis developed continual severe hypoglycemia several years after a Billroth II-Braun gastrectomy, and continuous glucose infusion could not be stopped even during ASVS tests. A 9-year-old girl with an insulinoma that showed atypical hypovascularity on imaging examinations had ASVS tests under a glucose clamp for safety. Hyperinsulinemic (≈100 μU/ml) euglycemic (≈90 mg/dl) clamps were achieved by an artificial endocrine pancreas. The insulin analogue lispro was utilized for clamps and endogenous insulin was measured with an assay that does not cross-react with the analogue. Diagnostically significant responses (more than twofold) of insulin secretion were observed under hyperinsulinemic clamps in both cases. The use of the hyperinsulinemic glucose clamp technique during the ASVS test should be considered for maintaining the safety of some hypoglycemic patients.<br>
Journal
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- Endocrine Journal
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Endocrine Journal 54 (1), 27-33, 2007
The Japan Endocrine Society
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Details 詳細情報について
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- CRID
- 1390001206299136000
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- NII Article ID
- 10019479174
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- NII Book ID
- AA10901436
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- COI
- 1:STN:280:DC%2BD2s7nvFSjuw%3D%3D
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- ISSN
- 13484540
- 09188959
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- Text Lang
- en
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- Data Source
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- JaLC
- Crossref
- CiNii Articles
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- Abstract License Flag
- Disallowed