Hypoglycemia echocardiography or ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Mohammed Abdelwahed M.D[3]


Transabdominal ultrasound has low sensitivity varying between 0-66% in detecting insulinoma. The sensitivity increases with the use of more invasive endoscopic ultrasound (93%) and intraoperative ultrasound (86%). Hypoechoic lesion and hypervascular mass are ultrasonographic findings.

Transabdominal Ultrasound

Invasive Ultrasound

Endoscopic Ultrasound

This is an invasive ultrasound which can be done pre-operatively. Its use has been increased with improve in its sensitivity. Endoscopic ultrasound is more accurate for pancreatic head insulinomas. It is the primary diagnostic modality for the diagnosis of pancreatic neuroendocrine tumors (which includes insulinoma).[1][2][3]

The advantages are:

  • It enables visualization of smaller tumors (2 mm)
  • Local metastasis and invasion can be detected
  • Higher resolutions

The disadvantages are invasiveness, high cost, availability, and expertise. {{#ev:youtube|TF1phjhRZLg}}

Intra-operative Ultrasound

It was introduced in 1981 and used to localize non-palpable lesions and those who are in close proximity to pancreas and bile ducts. This method can localize tumors in 86% of cases when performed during an open or laparoscopic surgery.[4][5]


  1. 1.0 1.1 McAuley, G.; Delaney, H.; Colville, J.; Lyburn, I.; Worsley, D.; Govender, P.; Torreggiani, W.C. (2005). "Multimodality preoperative imaging of pancreatic insulinomas". Clinical Radiology. 60 (10): 1039–1050. doi:10.1016/j.crad.2005.06.005. ISSN 0009-9260.
  2. Sotoudehmanesh R, Hedayat A, Shirazian N, Shahraeeni S, Ainechi S, Zeinali F; et al. (2007). "Endoscopic ultrasonography (EUS) in the localization of insulinoma". Endocrine. 31 (3): 238–41. PMID 17906369.
  3. Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM (2000). "Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas". Am J Gastroenterol. 95 (9): 2271–7. doi:10.1111/j.1572-0241.2000.02480.x. PMID 11007228.
  4. Brown CK, Bartlett DL, Doppman JL, Gorden P, Libutti SK, Fraker DL; et al. (1997). "Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas". Surgery. 122 (6): 1189–93, discussion 1193-4. PMID 9426437.
  5. Grover AC, Skarulis M, Alexander HR, Pingpank JF, Javor ED, Chang R; et al. (2005). "A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas". Surgery. 138 (6): 1003–8, discussion 1008. doi:10.1016/j.surg.2005.09.017. PMID 16360384.