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68Ga-Exendin-4 PET/CT 诊断异位胰岛素瘤：病例报告及文献复习。

Ectopic insulinoma diagnosed by 68Ga-Exendin-4 PET/CT: A case report and review of literature.

机构信息

Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital.

Nankai University State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, China.

出版信息

Medicine (Baltimore). 2021 Apr 2;100(13):e25076. doi: 10.1097/MD.0000000000025076.

DOI:10.1097/MD.0000000000025076
PMID:33787590
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8021326/
Abstract

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 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.

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 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.

摘要

理由

异位胰岛素瘤非常罕见，临床医生诊断极具挑战性。精确的术前定位对于成功治疗至关重要。

患者关注

一名 23 岁男性，有 1 年反复发作性低血糖病史。

诊断

当地医院的检查未发现胰腺病变。入院后，空腹试验和 5 小时口服葡萄糖耐量试验（OGTT）提示内源性高胰岛素血症性低血糖症的诊断。增强容积灌注计算机断层扫描（VPCT）显示胰腺尾部有 2 个结节，胃窦部有 1 个结节，脾脏门部有 1 个结节。为了区分哪个结节是导致低血糖的原因，我们进行了 68Ga-Exendin-4 PET/CT 和 68Ga-DOTATATE PET/CT，有助于明确诊断胃窦部病变为异位胰岛素瘤。

干预措施

患者接受了微创腹腔镜肿瘤切除术，得以治愈。

结果

术后症状缓解，血糖水平保持正常。

结论

本例表明 68 镓-Exendin-4 PET/CT 有助于精确定位，从而成功治疗胰岛素瘤，特别是隐匿性胰岛素瘤和来源于异位胰腺的胰岛素瘤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/ccfb4174b5b1/medi-100-e25076-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/b85b45d86dd3/medi-100-e25076-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/c76f7286f1ee/medi-100-e25076-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/ffef1b1b15cc/medi-100-e25076-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/9a2a35f1ca31/medi-100-e25076-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/a29c42f7b93a/medi-100-e25076-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/8a225ef322bd/medi-100-e25076-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/ccfb4174b5b1/medi-100-e25076-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/b85b45d86dd3/medi-100-e25076-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/c76f7286f1ee/medi-100-e25076-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/ffef1b1b15cc/medi-100-e25076-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/9a2a35f1ca31/medi-100-e25076-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/a29c42f7b93a/medi-100-e25076-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/8a225ef322bd/medi-100-e25076-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/591a/8021326/ccfb4174b5b1/medi-100-e25076-g007.jpg

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