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Article
June 24, 1988

Localization and Resection of Insulinomas and Gastrinomas

Author Affiliations

From the Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md.

From the Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md.

JAMA. 1988;259(24):3601-3605. doi:10.1001/jama.1988.03720240063036
Abstract

SELECTED CASES 

Case 1  A 45-YEAR-OLD woman with a threeyear history of epigastric pain was treated initially with cimetidine and then with ranitidine hydrochloride and antacids, with only mild relief. Her fasting serum gastrin level was elevated at 496 ng/L (496 pg/mL) (normal, <100 ng/L [<100 pg/mL]). Her basal acid output was 32 mEq/h (normal, <15 mEq/h). The results of her secretin stimulation test were abnormal, with a rise in the serum gastrin level from 239 ng/L (239 pg/mL) at baseline to 825 ng/L (825 pg/mL) (abnormal increment, >200 ng/L [>200 pg/mL]). Ultrasound, computed tomographic (CT) scan, and selective angiogram all failed to demonstrate a gastrinoma. Selective venous sampling was performed and a marked step-up in gastrin levels was found in the superior pancreaticoduodenal vein (Fig 1). The patient underwent an exploratory laparotomy, and intraoperative ultrasound demonstrated a lesion in the posterior head of the pancreas (Fig 2). After enucleation,

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