Fig. 2

Selective arterial calcium stimulation test in the case. A Selective arterial calcium stimulation test (SACST) was performed after confirming vascular supply of the pancreas by computer tomography angiography. Insulin levels are plotted before and after injection of calcium gluconate into indicated arteries. As she experienced hypoglycemia (plasma glucose level 30 mg/dL or less) during SACST, 50% glucose solution was given intravenously before injection of calcium gluconate into the arteries denoted by asterisks (i.e., the superior mesenteric artery and the distal splenic artery). B Fold changes in insulin levels before and 60 s after injection of calcium gluconate (Insulin 60 s/Insulin 0 s) are shown for each indicated artery. Note that fold changes for the superior mesenteric artery and the distal splenic artery are relatively low, presumably because insulin levels before the injection of calcium gluconate were relatively high and the patient had experienced hypoglycemia and received intravenous injection of 50% glucose solution. C Computer tomography angiography visualization of the vascular supply of the pancreas. Note that injection of contrast medium into the hepatic artery proper and the superior mesenteric artery did not result in significant contrast effects in the pancreas. D Schematics of the vascular supply in the pancreas. Note that the gastroduodenal artery feeds a relatively large area of the pancreas (head and body)