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DOI: 10.4103/wjnm.WJNM_41_19
Extrapancreatic insulinoma
Abstract
A 38-year-old female presented with recurrent episodes of hypoglycemia for 5 years. On 72-h fast test, critical sample biochemistry was suggestive of endogenous hyperinsulinemic hypoglycemia. Both constrast-enhanced computed tomography and 68Ga-DOTATATE positron emission tomography/computerized tomography (PET/CT) revealed no pancreatic lesion but showed a jejunal lesion suggestive of neuroendocrine tumor (NET) but not confirmatory of insulinoma. 68Ga-Exendin-4 PET/CT showed intense uptake in the proximal jejunum, and this being a specific scan for insulinoma, confirmed it as an ectopic insulinoma. The patient attained normoglycemia after excision of this NET confirming it to be a case of ectopic insulinoma located in the jejunum. Although most insulinomas are located in the pancreas, rarely ectopic cases have been described in the spleen, perisplenic tissue, duodenohepatic ligament, adjacent to the ligament of Treitz, duodenum, and the jejunum. Functional scanning with 68Ga-Exendin-4 PET/CT scan aids the localization of ectopic insulinoma.
Keywords
68Ga-Exendin-4 positron emission tomography/computerized tomography - 68Ga-DOTATATE positron emission tomography/computerized tomography - ectopic jejunal insulinomaFinancial support and sponsorship
Nil.
Publication History
Received: 26 March 2019
Accepted: 14 July 2019
Article published online:
19 April 2022
© 2020. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Service FJ, McMahon MM, O'Brien PC, Ballard DJ. Functioning insulinoma – Incidence, recurrence, and long-term survival of patients: A 60-year study. Mayo Clin Proc 1991;66:711-9.
- 2 Hennings J, Garske U, Botling J, Hellman P. Malignant insulinoma in ectopic pancreatic tissue. Dig Surg 2005;22:377-9.
- 3 Xian-Ling W, Yi-Ming M, Jing-Tao D, Wen-Wen Z, Zhao-Hui L, Rong L, et al. Successful laparoscope resection of ectopic insulinoma in duodenohepatic ligament. Am J Med Sci 2011;341:420-2.
- 4 Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and management of adult hypoglycemic disorders: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2009;94:709-28.
- 5 Abboud B, Boujaoude J. Occult sporadic insulinoma: Localization and surgical strategy. World J Gastroenterol 2008;14:657-65.
- 6 Ourô S, Taré F, Moniz L. Pancreatic ectopia. Acta Med Port 2011;24:361-6.
- 7 Nockel P, Babic B, Millo C, Herscovitch P, Patel D, Nilubol N, et al. Localization of insulinoma using 68Ga-DOTATATE PET/CT scan. J Clin Endocrinol Metab 2017;102:195-9.
- 8 Antwi K, Fani M, Nicolas G, Rottenburger C, Heye T, Reubi JC, et al. Localization of hidden insulinomas with 68Ga-DOTA-exendin-4 PET/CT: A pilot study. J Nucl Med 2015;56:1075-8.
- 9 Luo Y, Yao S, Li F. 68Ga-exendin-4 PET/CT is both sensitive and specific in diagnosing insulinomas. J Nucl Med 2017;58 Suppl 1:237.