PMID- 12720536
OWN - NLM
STAT- MEDLINE
DCOM- 20030625
LR  - 20190906
IS  - 0804-4643 (Print)
IS  - 0804-4643 (Linking)
VI  - 148
IP  - 5
DP  - 2003 May
TI  - Pitfalls in endosonographic imaging of suspected insulinomas: pancreatic nodules 
      of unknown dignity.
PG  - 531-4
AB  - OBJECTIVE: Endosonography enables localization and characterization of 
      gastroenteropancreatic neuroendocrine tumors. We have studied the problem of 
      misleading abnormalities of pancreatic morphology as obtained by endosonographic 
      imaging. DESIGN AND METHODS: A total of 438 endosonographies performed for known 
      or suspected diseases of the adrenal glands and/or the pancreas and/or suspected 
      metastases in the neighboring tissues were analyzed. RESULTS: In the pancreas, 
      nine benign insulinomas, four non-metastatic islet cell carcinomas, and multiple 
      benign neuroendocrine tumors in one patient with multiple-endocrine neoplasia-1 
      (MEN-1) disease were detected and correctly localized as proven by postoperative 
      histology. In three further patients with genetic diagnosis of MEN-1, 
      asymptomatic tumors were detected and are under observation. However, we also 
      found an 8 x 4 mm hypoechoic tumor in the cauda pancreatis of a patient with 
      severe factitial hypoglycemia (glimepiride). In another patient suffering from 
      severe hypoglycemia, a hypoechoic area of 24 x 10 mm in the processus 
      uncinatus/caput pancreatis was found. Although organic hyperinsulinism was 
      excluded, this patient underwent surgery because of suspected pancreatic 
      carcinoma. There was normal pancreatic tissue in the abnormal region, which was 
      also localized by intraoperative sonography. In a third patient with an adrenal 
      carcinoma, a 6 x 3 mm hypoechoic nodule in the cauda pancreatis did not change 
      its morphology over an observation period of 13 months, its clinical relevance is 
      completely unclear. CONCLUSIONS: Pancreatic nodules of unknown dignity were 
      detected in nearly 1% of our patients and must be considered to be a diagnostic 
      problem. These experiences clearly show, on the one hand, that pancreatic 
      endosonography is a very useful diagnostic support in the management of endocrine 
      tumor patients. However, on the other hand, endosonography of endocrine organs is 
      not a substitute for careful endocrinological examination and testing and must be 
      considered in the context of endocrinological findings.
FAU - Kann, P H
AU  - Kann PH
AD  - Division of Endocrinology and Diabetology, Clinic for Gastroenterology, 
      Endocrinology and Metabolism, Centre for Internal Medicine, Philipps University 
      Medical School, D-35033 Marburg, Germany. Kannp@med.uni-marburg.de
FAU - Wirkus, B
AU  - Wirkus B
FAU - Keth, A
AU  - Keth A
FAU - Goitom, K
AU  - Goitom K
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur J Endocrinol
JT  - European journal of endocrinology
JID - 9423848
SB  - IM
MH  - Aged
MH  - Diagnostic Errors
MH  - *Endosonography
MH  - Female
MH  - Humans
MH  - Insulinoma/*diagnostic imaging
MH  - Male
MH  - Middle Aged
MH  - Pancreas/diagnostic imaging
MH  - Pancreatic Neoplasms/*diagnostic imaging
EDAT- 2003/05/02 05:00
MHDA- 2003/06/26 05:00
CRDT- 2003/05/02 05:00
PHST- 2003/05/02 05:00 [pubmed]
PHST- 2003/06/26 05:00 [medline]
PHST- 2003/05/02 05:00 [entrez]
AID - 10.1530/eje.0.1480531 [doi]
PST - ppublish
SO  - Eur J Endocrinol. 2003 May;148(5):531-4. doi: 10.1530/eje.0.1480531.