Open AccessEctopic insulinoma diagnosed by 68Ga-Exendin-4 PET/CT
Author(s) -
Xiaona Zhang,
Hongwei Jia,
Fengao Li,
Chunyun Fang,
Jinyang Zhen,
Qing He,
Ming Liu
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000025076
Subject(s) - medicine , insulinoma , ectopic pancreas , hypoglycemia , nodule (geology) , pancreas , radiology , antrum , occult , pet ct , lesion , hyperinsulinemic hypoglycemia , positron emission tomography , stomach , surgery , pathology , insulin , paleontology , alternative medicine , biology
Rationale: Ectopic insulinomas are extremely rare and challenging to diagnose for clinicians. Precise preoperative localization is essential to successful treatment. Patient concerns: A 23-year-old man presented with a 1-year history of recurrent hypoglycemia. Diagnosis: 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 68 Ga-Exendin-4 PET/CT and 68 Ga-DOTATATE PET/CT which helped to make a conclusive diagnosis that the lesion in the gastric antrum was an ectopic insulinoma. Interventions: The patient was cured with minimally invasive laparoscopic resection of the tumor. Outcomes: The symptoms were relieved and the blood glucose level remained normal after surgery. Conclusions: This case shows that 68 Gallium-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.