ArticleSurgical case reports2025
A Case of Curative Resection by Minimally Invasive Surgery in Two Stages Using the Hormonal Mapping Test for Pancreatic Head ACTHoma with Multiple Liver Metastases.
Article in Surgical case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSymptom control is sometimes as important as tumor burden control in patients with functional neuroendocrine tumors (NETs). The selective arterial calcium injection (SACI) test is widely used to localize functional NETs, particularly insulinomas and gastrinomas; however, its utility in adrenocorticotropic hormone (ACTH)-producing tumors (ACTHomas) remains unclear. We present a case of a pancreatic head ACTHoma with synchronous liver metastases in which the SACI test with venous sampling ("hormonal mapping") enabled a safe, staged curative resection. CASE PRESENTATION: A 42-year-old woman presented with features of Cushing's syndrome, including edema and weight gain. CT revealed a pancreatic head tumor with multiple liver metastases. Liver biopsy confirmed the diagnosis of NET, suggesting an ACTHoma. Hormonal mapping demonstrated that liver metastases, rather than the pancreatic tumor, were the predominant sources of ACTH secretion. To achieve hormonal control, we prioritized laparoscopic liver resection, followed by laparoscopic pancreatoduodenectomy three months later after confirming the absence of new metastatic lesions. At 21 months postoperatively, the patient remains recurrence-free.
conclusionsHormonal mapping was effective in identifying hormone-producing lesions and guiding surgical strategies for ACTHomas with liver metastases.
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