Pediatr. praxi 2018; 19(2): 109-112 | DOI: 10.36290/ped.2018.023

Use of endoscopic contrast-enhanced ultrasonography and elastography in diagnostic of insulinoma
in an adolescent patient

MUDr. Marek Pršo¹, MUDr. Alena Szökeová¹, MUDr. Zuzana Havličeková, PhD.¹, MUDr. Zuzana Michnová, PhD.¹, MUDr. Denisa Raffajová¹, Mgr. Mária Jančinová¹, prof. MUDr. Peter Bánovčin, CSc.¹, MUDr. Peter Bánovčin, PhD.², MUDr. Peter Uhrík², prof. MUDr. Rudolf Hyrdel, CSc.²

Klinika detí a dorastu, Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta v Martine,

¹ Univerzitná nemocnica Martin, Slovensko

Interná klinika gastroenterologická, Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta v Martine,

² Univerzitná nemocnica Martin, Slovensko

In this case study, the authors investigate the condition of a 15,5 year old patient with insulinoma presenting with predominantly neurologicalsymptoms (numbnes in upper limba, lips, and tongue, psychomotor retardation) triggered by recurrent severe hypoglycemia.The initial abdominal ultrasound did not verify any tumorous mass. Subsequent imaging examinations (abdominal ultrasound, endoscopicultrasound, CT, MRI, PET/CT scans, scintigraphy) yielded significantly discrepant results. Only the use of contrast-enhancedendoscopic ultrasonograhy and elastometry identified a small lesion at the junction of the head and the body of the pancreas,non-homogenous in structure with slightly raised echogenicity and discreetly increased blood flow during the contrast-enhancedphase. The elastometry revealed lowered elasticity of the lesion in comparison with the surrounding pancreatic tissue. Based onthese findings, the lesion was suspected to be an insulinoma. Probatory surgical laparotomy was performed, during which a tumorwas identified and successfully removed. Histological findings confirmed a neuroendocrine neoplasia of the insulinoma variety.The patient is currently without neuroglycopenic symptoms, treated as a pediatric endocrinology and gastroenterology outpatient.

Keywords: contrast-enhanced endoscopic ultrasonography, elastometry, insulinoma, childhood

Published: May 1, 2018  Show citation