Sakaki Kentaro, Murakami Takaaki, Fujimoto Hiroyuki, Shimizu Yoichi, Miyake Kanae Kawai, Otani Daisuke, Otsuki Shinya, Shimizu Hironori, Nagai Kazuyuki, Nomura Takumi, Yabe Daisuke, Nakamoto Yuji, Inagaki Nobuya
Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Radioisotope Research Center, Agency for Health, Safety and Environment, Kyoto University, Kyoto, Japan.
Front Endocrinol (Lausanne). 2025 May 8;16:1556813. doi: 10.3389/fendo.2025.1556813. eCollection 2025.
Insulinomas, the most common functional pancreatic neuroendocrine tumors, cause hypoglycemia due to excessive insulin production, leading to severe clinical symptoms like coma or death. Resection surgery is the major curative treatment, but preoperative localization is challenging due to their small size. Traditional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI) often fail to detect tumors, while more invasive procedures like endoscopic ultrasound tissue acquisition (EUS-TA) and the selective arterial calcium stimulation test (SACST), though informative, depend heavily on operator skill and may not always provide conclusive results. There is an urgent need for non-invasive, sensitive localization methods for insulinomas. Glucagon-like peptide 1 receptor (GLP-1R) targeted PET imaging has emerged as a promising tool. We present a clinical case where [F] FB (ePEG12)12-exendin-4 positron emission tomography/CT (F-exendin-4 PET/CT) successfully detected insulinoma, unachievable by conventional imaging, underscoring its potential in guiding minimally invasive surgery.
A 67-year-old female developed hyperinsulinemic hypoglycemia but could not undergo surgery as conventional imaging methods failed to localize the insulinoma. She was managed with diazoxide for six years, but her symptoms worsened. At 73, she was referred to our hospital. CT, MRI, endoscopic ultrasound, and SACST failed to detect the tumor in any artery. However, F-exendin-4 PET/CT revealed a nodule with uptake in the dorsal pancreas, suspected to be the culprit lesion. The patient underwent surgery, and although the tumor appeared discontinuous with the pancreas macroscopically, histopathology confirmed it was microscopically continuous, identifying it as a primary pancreatic insulinoma. Post-surgery, she achieved complete remission of symptoms and fully recovered.
This case demonstrates the utility of F-exendin-4 PET/CT, a novel GLP-1 receptor-targeted imaging technique, in accurately localizing an occult insulinoma even with negative findings of SACST, enabling minimally invasive curative surgery.
The F-exendin-4 PET/CT successfully localized an insulinoma undetectable by other methods, enabling minimally invasive curative resection. This technique offers a valuable diagnostic option for enabling minimally invasive surgery in occult insulinoma cases.
胰岛素瘤是最常见的功能性胰腺神经内分泌肿瘤，因胰岛素分泌过多导致低血糖，可引发昏迷或死亡等严重临床症状。手术切除是主要的根治性治疗方法，但由于肿瘤体积小，术前定位具有挑战性。传统的成像方法如计算机断层扫描（CT）和磁共振成像（MRI）常常无法检测到肿瘤，而更具侵入性的操作如内镜超声组织获取（EUS-TA）和选择性动脉钙刺激试验（SACST），尽管能提供信息，但严重依赖操作者的技能，且不一定总能得出确凿结果。迫切需要用于胰岛素瘤的非侵入性、灵敏的定位方法。胰高血糖素样肽1受体（GLP-1R）靶向正电子发射断层显像已成为一种有前景的工具。我们报告一例临床病例，[F] FB（ePEG12）12-艾塞那肽-4正电子发射断层显像/计算机断层扫描（F-艾塞那肽-4 PET/CT）成功检测到常规成像无法发现的胰岛素瘤，凸显了其在指导微创手术方面的潜力。
一名67岁女性出现高胰岛素血症性低血糖，但由于常规成像方法未能定位胰岛素瘤，无法进行手术。她使用二氮嗪治疗了六年，但症状恶化。73岁时，她被转诊至我院。CT、MRI、内镜超声和SACST均未能在任何动脉中检测到肿瘤。然而，F-艾塞那肽-4 PET/CT显示胰腺背侧有一个摄取结节，怀疑是罪魁祸首病变。患者接受了手术，尽管肿瘤在宏观上与胰腺不连续，但组织病理学证实其在微观上是连续的，确定为原发性胰腺胰岛素瘤。术后，她症状完全缓解并完全康复。
本病例证明了F-艾塞那肽-4 PET/CT这一新型GLP-1受体靶向成像技术的实用性，即使在SACST结果为阴性的情况下，也能准确地定位隐匿性胰岛素瘤，从而实现微创根治性手术。
F-艾塞那肽-4 PET/CT成功定位了其他方法无法检测到的胰岛素瘤，实现了微创根治性切除。该技术为隐匿性胰岛素瘤病例的微创手术提供了一种有价值的诊断选择。
