Localization of gastrinomas by selective intra-arterial calcium injection
| Autor: | K. Meeran, Rajesh V. Thakker, Jeremy Turner, J. E. Jackson, A. M. Wren |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
medicine.medical_specialty
Gastrinoma business.industry Endocrinology Diabetes and Metabolism chemistry.chemical_element Calcium medicine.disease digestive system digestive system diseases Secretin Endocrinology medicine.anatomical_structure chemistry Gastrointestinal hormone Internal medicine medicine Duodenum Secretagogue Pancreas business hormones hormone substitutes and hormone antagonists Gastrin |
| Zdroj: | Clinical Endocrinology. 57:821-825 |
| ISSN: | 0300-0664 |
| Popis: | BACKGROUND Preoperative localisation is important for successful surgical treatment of gastrinomas. However, a satisfactory method that achieves this has not been defined, and at present somatostatin receptor scintigraphy and selective intra-arterial stimulation testing with secretin have the greatest sensitivities. As secretin is now difficult to obtain, we decided to explore the use of calcium gluconate as a secretagogue. High extracellular calcium concentrations cause degranulation of neuroendocrine cells and subsequent release of hormone. METHODS Two patients with biochemically proven gastrinomas were investigated pre-operatively. Under angiographic control calcium gluconate was injected into the arteries supplying the pancreas and duodenum, gastrin levels were then determined in hepatic vein samples obtained before and 30, 60, 90, 120 and 180 seconds after each injection. One of the patients had also previously undergone selective intra-arterial stimulation testing with secretin. RESULTS Calcium gluconate produced sharp peaks of gastrin which unequivocally localised the tumour to a specific vascular territory in each case. Furthermore, surgery confirmed the localisations of the gastrinomas. Calcium injection, unlike secretin, into vascular territories without gastrinomas caused no rise in gastrin, thereby demonstrating calcium's greater specificity. CONCLUSIONS Calcium gluconate is a highly sensitive and specific alternative secretagogue to secretin for localisation of pancreatic and duodenal gastrinomas. Furthermore calcium gluconate was found to demonstrate the territory of the tumour more accurately than secretin. |
| Databáze: | OpenAIRE |
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