Abstract
Severe hypoglycemia was documented in a 3 months old child and hyperinsulinism was ascertained by glucose-insulin measurement in several blood samples. To further understand the cause of this hyperinsulinism, retrograde splenic vein catheterism was performed by transhepatic punction of the portal vein. Blood samples (n=14) were taken in the splenic vein from the tail to the isthmus and in the outcoming vein from the head. In one sample high insulin (140 μu/ml-other samples ranging from 10 to 40.5) was documented suggesting a secreting lesion localised in the isthmus of the pancreas according to the localisation of the tip of the catheter. During surgery a 3mm lesion was found by lens examination of the pancreas at the exact place indicated by selective catheterism and insulin assay. Hypoglycemia resumed immediatly after partial pancreatectomy and the child remained normoglycemic at 3 months follow up. Histological analysis of the removed pancreas confirms the presence of a single focal lesion with normal size nuclei in the β-cells of the remaining part of the gland.
In conclusion : As reported in adults selective portal catheterism is of value in the localisation of a secreting lesion of the pancreas in infantile hyperinsulinism. This introduces a rational approach in the discussion of the extent of the pancreatectomy.
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Saudubray, J., Brunelles, F., Lombes, A. et al. HYPERINSULINISM IN INFANCY: TOPOGRAPHICAL LOCALISATION OF A PANCREATIC FOCAL LESION BY TRANSHEPATIC PORTAL CATHETERISM, SELECTIVE BLOOD SAMPLING AND INSULIN MEASUREMENT. Pediatr Res 20, 1205 (1986). https://doi.org/10.1203/00006450-198611000-00189
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DOI: https://doi.org/10.1203/00006450-198611000-00189
