Open Access99mTc Labeled Glucagon-Like Peptide-1-Analogue (99mTc-GLP1) Scintigraphy in the Management of Patients with Occult Insulinoma
Author(s) -
Anna SowaStaszczak,
Małgorzata Trofimiuk–Müldner,
Agnieszka Stefańska,
Monika Tomaszuk,
Monika Buziak-Bereza,
Aleksandra GilisJanuszewska,
Agata JabrockaHybel,
Bogusław Głowa,
Maciej T. Małecki,
Tomasz Bednarczuk,
Grzegorz Kamiński,
Aldona Kowalska,
Renata Mikołajczak,
Barbara Janota,
Alicja HubalewskaDydejczyk
Publication year - 2016
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0160714
Subject(s) - insulinoma , medicine , scintigraphy , hypoglycemia , occult , hyperinsulinemic hypoglycemia , nesidioblastosis , postprandial , radiology , insulin , gastroenterology , nuclear medicine , pathology , alternative medicine
The aim of this study was to assess the utility of [Lys 40 (Ahx-HYNIC- 99m Tc/EDDA)NH 2 ]-exendin-4 scintigraphy in the management of patients with hypoglycemia, particularly in the detection of occult insulinoma. Materials and Methods Forty patients with hypoglycemia and increased/confusing results of serum insulin and C-peptide concentration and negative/inconclusive results of other imaging examinations were enrolled in the study. In all patients GLP-1 receptor imaging was performed to localise potential pancreatic lesions. Results Positive results of GLP-1 scintigraphy were observed in 28 patients. In 18 patients postsurgical histopathological examination confirmed diagnosis of insulinoma. Two patients had contraindications to the surgery, one patient did not want to be operated. One patient, who presented with postprandial hypoglycemia, with positive result of GLP-1 imaging was not qualified for surgery and is in the observational group. Eight patients were lost for follow up, among them 6 patients with positive GLP-1 scintigraphy result. One patient with negative scintigraphy was diagnosed with malignant insulinoma. In two patients with negative scintigraphy Munchausen syndrome was diagnosed (patients were taking insulin). Other seven patients with negative results of 99m TcGLP-1 scintigraphy and postprandial hypoglycemia with C-peptide and insulin levels within the limits of normal ranges are in the observational group. We would like to mention that 99m Tc-GLP1-SPECT/CT was also performed in 3 pts with nesidioblastosis (revealing diffuse tracer uptake in two and a focal lesion in one case) and in two patients with malignant insulinoma (with the a focal uptake in the localization of a removed pancreatic headin one case and negative GLP-1 1 scintigraphy in the other patient). Conclusions 99m Tc-GLP1-SPECT/CT could be helpful examination in the management of patients with hypoglycemia enabling proper localization of the pancreatic lesion and effective surgical treatment. This imaging technique may eliminate the need to perform invasive procedures in case of occult insulinoma.