Ambulkar Ketki Sunil, Shah Ravikumar, Lila Anurag, Sharma Anima, Barnabas Rohit, Karlekar Manjiri, Memon Saba Samad, Sarathi Vijaya, Rege Sameer, Verma Priyanka, Malhotra Gaurav, Lele Vikram, Bandgar Tushar
Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Mumbai, India.
Harikrushna Hormone Clinic, Anand, India.
Horm Metab Res. 2025 Jun;57(6):366-372. doi: 10.1055/a-2620-2931. Epub 2025 May 23.
The data on the use of 68Ga-NODAGA-exendin-4 PET/CT in localizing multiple endocrine neoplasia type 1 (MEN1)-related insulinomas is evolving; however, surgical outcomes data are not available. We describe our cohort of patients with MEN1-related endogenous hyperinsulinemic hypoglycemia (EHH), where 68Ga-NODAGA-exendin-4 PET/CT was used to guide conservative surgery. A retrospective record review of MEN1-related EHH cases managed between 2000 and 2024 was performed for clinical features, imaging, and management. Outcomes were assessed for patients whose surgical extent was determined by 68Ga-NODAGA-exendin-4 PET/CT versus conventional imaging (CECT and 68Ga-DOTATATE PET/CT). Five patients with a median age of 17 (15.5-18.5 years) with EHH underwent laparoscopic, single lesion enucleation based on 68Ga-NODAGA-exendin-4 PET/CT. On preoperative imaging, CT identified culprit lesion in four, while 68Ga-DOTATATE PET/CT localized in one, and had one false positive uptake in non-functioning NET. The median duration of hospital stay was 6 (5.5-9) days. Over a median follow-up of 48 (3.5-84.5) months, none had EHH recurrence or exocrine/endocrine pancreatic insufficiency. On follow-up, one patient had an uneventful pregnancy and delivery. In the remaining 15, who underwent surgery based on conventional imaging, 12 (80%) required extensive surgery beyond enucleation, of which two needed intraoperative ultrasound localization. This group had a postoperative hospital stay of 11 (8-23) days, one recurrence after 84 months, and pancreatic insufficiency in 5 (33%). Our center observation suggests that GLP1R-based PET/CT-guided conservative insulinoma surgery in MEN1 patients is effective and safe and needs further validation.
关于68Ga-NODAGA-艾塞那肽-4 PET/CT在定位1型多发性内分泌肿瘤（MEN1）相关胰岛素瘤中的应用数据仍在不断发展；然而，尚无手术结果数据。我们描述了一组MEN1相关的内源性高胰岛素血症性低血糖症（EHH）患者，其中使用68Ga-NODAGA-艾塞那肽-4 PET/CT来指导保守手术。对2000年至2024年间管理的MEN1相关EHH病例进行回顾性记录审查，以了解临床特征、影像学表现和治疗情况。对手术范围由68Ga-NODAGA-艾塞那肽-4 PET/CT与传统影像学检查（增强CT和68Ga-DOTATATE PET/CT）确定的患者的结局进行评估。5例中位年龄为17岁（15.5 - 18.5岁）的EHH患者基于68Ga-NODAGA-艾塞那肽-4 PET/CT接受了腹腔镜单病灶摘除术。术前影像学检查中，CT在4例中发现了可疑病灶，而68Ga-DOTATATE PET/CT仅在1例中定位到病灶，且在无功能神经内分泌肿瘤中有1例假阳性摄取。中位住院时间为6（5.5 - 9）天。在中位随访48（3.5 - 84.5）个月期间，无患者出现EHH复发或胰腺外分泌/内分泌功能不全。随访时，1例患者妊娠和分娩过程顺利。其余15例基于传统影像学检查接受手术的患者中，12例（80%）需要进行除摘除术之外的广泛手术，其中2例需要术中超声定位。该组患者术后住院时间为11（8 - 23）天，1例在84个月后复发，5例（33%）出现胰腺功能不全。我们中心的观察结果表明，基于GLP1R的PET/CT引导下的MEN1患者保守性胰岛素瘤手术有效且安全，但需要进一步验证。
