Endocrine Journal
Online ISSN : 1348-4540
Print ISSN : 0918-8959
ISSN-L : 0918-8959
ORIGINALS
Insulin Responses to Selective Arterial Calcium Infusion under Hyperinsulinemic Euglycemic Glucose Clamps: Case Studies in Adult Nesidioblastosis and Childhood Insulinoma
Atsushi NAKAGAWA, Keiichi UENO, Masatsune ITO, Shinya OKAMOTO, Keigo UEHARA, Hiroki ITO, Suguru MISHINA, Eriko KINOSHITA, Takayuki NOJIMA, Hiroaki TAKAHASHI, Hiromichi IKAWA, Shigeki TAKASHIMA, Makoto NISHIZAWA, Shigeru NAKANO, Toshikazu KIGOSHI, Hajime NAKABAYASHI, Kenzo UCHIDA
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Keywords: Hypoglycemia, Selective arterial calcium stimulation and hepatic venous sampling, Hyperinsulinemic glucose clamp, Insulinoma, Adult nesidioblastosis
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2007 Volume 54 Issue 1 Pages 27-33

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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.

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