Localization of glucagonomas by catheterization of the pancreatic veins and with glucagon assay.

In two patients with the glucagonoma syndrome, percutaneous transhepatic puncture of the portal vein and catheterization of the pancreatic veins were performed simultaneously with catheterization of the inferior vena cava and abdominal aorta. Blood samples obtained from the vena cava, aorta and portal branches were assayed for glucagon. In both patients, clearcut arteriovenous glucagon differences allowed preoperative localization of the tumors. A comparison with other localization techniques, such as scintiscan, ultrasound, arteriography and pancreatic phlebography, showed the present method to be superior. Postoperatively, the same investigations were performed revealing arterial and venous glucagon levels comparable to the levels measured in a reference group of three patients without glucagonomas. The triple catheterization technique is advocated for all patients with clinical and laboratory findings that suggest pancreatic endocrine tumors.