Details

Autor(en) / Beteiligte

• Nakamura, Yoshio
• Doi, Ryuichiro
• Kohno, Yasuhiro
• Shimono, Dai
• Kuwamura, Naomitsu
• Inoue, Koichi
• Koshiyama, Hiroyuki
• Imamura, Masayuki

Titel

High-dose calcium stimulation test in a case of insulinoma masquerading as hysteria

Ist Teil von

• Endocrine, 2002-11, Vol.19 (2), p.127-130

Ort / Verlag

United States

Erscheinungsjahr

2002

Quelle

MEDLINE

Beschreibungen/Notizen

• It is reported that some cases with insulinoma present with neuropsychiatric symptoms and are often misdiagnosed as psychosis. Here we report a case of insulinoma masquerading as hysteria, whose final diagnosis could be made using high-dose calcium stimulation test. A 28-yr-old woman was referred presenting with substupor, mutism, mannerism, restlessness, and incoherence. Laboratory examinations revealed hypoglycemia (33 mg/dL) and detectable insulin levels (9.7 microU/mL), suggesting the diagnosis of insulinoma. However, neither imaging studies nor selective arterial calcium injection (SACI) test with a conventional dose of calcium (0.025 mEq/kg) indicated the tumor. High-dose calcium injection (0.05 mEq/kg) evoked insulin secretion when injected into superior mesenteric artery. A solitary tumor in the head of the pancreas was resected, and her plasma glucose returned to normal. Postoperatively, iv injection of secretin resulted in a normal response of insulin, which was not found preoperatively. This case suggests the usefulness of the SACI test with high-dose of calcium in the case of insulinoma when the standard dose fails to detect such a tumor.