LOCALIZATION OF B-CELL ADENOMA BY TRANSHE PATIC PORTAL CATHETERIZATION

Background. The procedures used to locate pancreatic endocrine tumors have only limited success in infants and children in whom the nodules may be small. Portal catheterization may therefore be useful. Cass rep ort. A child aged 6 yrs 4 months was admitted because of several recen t episodes of pallor and sweating associated with hypoglycemia. Furthe r investigation showed moderate hyperinsulinemia and low blood levels of ketone bodies and branched amino-acids after a 15 hr fast. Celiac a ngiography was normal. The hypoglycemic episodes recurred despite trea tment with diazoxide for 6 months. A transparietal portal catheterizat ion was therefore performed. Selective pancreatic venous sampling show ed high concentrations of insulin in two small veins draining one part of the head of the pancreas (117 and 89 mu U/ml). The head of pancrea s was removed 16 months later. Extemporaneous examination revealed an adenoma 0.8 cm in diameter. This patient has completely recovered, 8 m onths after surgery. Conclusion. Transparietal portal catheterization can detect pancreatic areas with high insulin secretion. It may also h elp the interpretation of celiac angiographs in children, as diagnosis may be obscured by the normal rich vascularity of the pancreas in the se patients.