gallium-ga-68-dotatate and Hypoglycemia

Ectopic insulinomas are extremely rare and challenging to diagnose for clinicians. Precise preoperative localization is essential to successful treatment.. A 23-year-old man presented with a 1-year history of recurrent hypoglycemia.. Examinations in the local hospital did not reveal any pancreatic lesion. After admission, a fasting test and a 5-hour oral glucose tolerance test (OGTT) suggested a diagnosis of endogenous hyperinsulinemic hypoglycemia. Enhanced volume perfusion computed tomography (VPCT) revealed 2 nodules in the tail of the pancreas, a nodule in the gastric antrum, and a nodule in the hilum of the spleen. To differentiate which nodule was responsible for hypoglycemia, we performed 68Ga-Exendin-4 PET/CT and 68Ga-DOTATATE PET/CT which helped to make a conclusive diagnosis that the lesion in the gastric antrum was an ectopic insulinoma.. The patient was cured with minimally invasive laparoscopic resection of the tumor.. The symptoms were relieved and the blood glucose level remained normal after surgery.. This case shows that 68Gallium-exendin-4 PET/CT is useful for precise localization and thereby successful treatment of insulinoma, especially for occult insulinomas and those derived from an ectopic pancreas.

Topics: Choristoma; Exenatide; Gallium Radioisotopes; Glucose Tolerance Test; Humans; Hypoglycemia; Insulinoma; Male; Organometallic Compounds; Pancreas; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Pyloric Antrum; Radiopharmaceuticals; Recurrence; Stomach Neoplasms; Young Adult

Topics: Aged, 80 and over; Asymptomatic Infections; Child, Preschool; China; COVID-19; COVID-19 Nucleic Acid Testing; Edetic Acid; Female; Gallium Isotopes; Gallium Radioisotopes; Humans; Hypoglycemia; Incidental Findings; Male; Neuroendocrine Tumors; Oligopeptides; Organometallic Compounds; Polymerase Chain Reaction; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiography, Thoracic; Sensitivity and Specificity

We report the case of a 46-year-old female patient who presented in the emergency department with intermittent disturbances of perception when fasting.. In the diagnostic fasting test, a hyperinsulinemic hypoglycemia already occurred after 7h. A sonographic examination was inconspicuous, therefore, a Ga 68-HA-DOTATATE positron emission tomography computed tomography (PET-CT) was carried out. The results were indicative of a neuroendocrine neoplasm, which gave rise to the suspicion of an insulinoma.. For surgical treatment the patient was transferred to an external hospital. Following surgery, the patient was free of symptoms.. If multiple symptoms of hypoglycemia are present, an insulinoma as the cause must be considered in the differential diagnostics.

Topics: Fasting; Female; Humans; Hypoglycemia; Insulinoma; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radionuclide Imaging