Endoscopic ultrasound localization of a pancreatic insulinoma: Case reportand review of the localization techniques

A 23-year-old male was referred to our hospital for evaluation of new-onset seizures. Signs and symptoms of neuroglycopenia, including weakness, dizzi ness, and confusion, appeared during fasting and resolved promptly with int ravenous dextrose administration. Insulin, proinsulin, and C-peptide levels were consistent with a diagnosis of insulinoma. Screening tests for multip le endocrine neoplasia type 1 and surreptitious sulfonylurea uses were nega tive. Preoperative localization of the insulinoma by transabdominal ultraso nography, computed tomography, and indium-lll octreoscanning were unsuccess ful. Endoscopic ultrasonography (EUS) identified a 6-to 7-mm tumor at the j uncture of the head and body of the pancreas. Surgical exploration confirme d the preoperative localization, and an 8-mm tumor was simply enucleated. T he patient has been free of symptoms for 18 months since surgery. This repo rt describes the utility of EUS to localize a solitary pancreatic insulinom a and provides a comparison of EUS and other preoperative localization tech niques.