A Case of Small Insulinoma Associated by Clinically Silent Glucagonoma

Shigenori Sugihara, Tetsuhiro Egami, Shigeyuki Tsurusaki, Hideo Ayame*, Kazuaki Nakai*

Department of Surgery, Department of Internal Medicine*, Shimonoseki Kousei Hospital

A 73-year-old woman was hospitalized with the chief complaint of episodes of unconsciousness. Endocrinological tests suggested insulinoma. During surgery for cholecystectomy, however, meticulous exploration did not detect any tumor. Four months later, the patient was readmitted. Magnetic resonance imaging (MRI) and arterial stimulation and venous sampling (ASVS) showed a tumor of 10 mm in diameter at the middle of the pancreas. Laparotomy was again performed. Intraoperative ultrasonography visualized two 5 mm tumors as low echoic masses at the middle of the pancreas, and these tumors were enucleated. Immunohistological examination for insulin, glucagon, gastrin and somatostatin gave the interesting result that one was insulinoma, and the other glucagonoma.

Key words
insulinoma, glucagonoma

Reprint requests
Shigenori Sugihara Department of Surgery, Shimonoseki Kousei Hospital
3-3-8 Kamishinchi, Shimonoseki, 750 JAPAN

Accepted
September 13, 1995

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