Utility of <superscript>68</superscript> Ga-DOTA-Exendin-4 positron emission tomography-computed tomography imaging in distinguishing between insulinoma and nesidioblastosis in patients with confirmed endogenous hyperinsulinaemic hypoglycaemia. - OpacWWW

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Tytuł:: Utility of Ga-DOTA-Exendin-4 positron emission tomography-computed tomography imaging in distinguishing between insulinoma and nesidioblastosis in patients with confirmed endogenous hyperinsulinaemic hypoglycaemia.
Autorzy:: Kalff V; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Iravani A; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; The Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Victoria, Australia.
Akhurst T; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; The Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Victoria, Australia.
Pattison DA; Department of Nuclear Medicine and Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Eu P; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Hofman MS; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; The Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Victoria, Australia.
Hicks RJ; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; The Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Victoria, Australia.; Neuroendocrine Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Źródło:: Internal medicine journal [Intern Med J] 2021 Oct; Vol. 51 (10), pp. 1657-1664.
Typ publikacji:: Case Reports; Journal Article
Język:: English
Imprint Name(s):: Original Publication: Carlton, Vic. : Blackwell Science Asia, c2001-
MeSH Terms:: Hypoglycemia*/diagnostic imaging
Hypoglycemia*/etiology
Insulinoma*/diagnostic imaging
Insulinoma*/surgery
Nesidioblastosis*
Pancreatic Neoplasms*/complications
Pancreatic Neoplasms*/diagnostic imaging
Exenatide ; Humans ; Positron Emission Tomography Computed Tomography ; Retrospective Studies
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Contributed Indexing:: Keywords: 68Ga-DOTA-Exendin-4; endogenous hyperinsulinaemic hypoglycaemia; insulinoma; nesidioblastosis; positron emission tomography
Substance Nomenclature:: 9P1872D4OL (Exenatide)
Entry Date(s):: Date Created: 20201214 Date Completed: 20211025 Latest Revision: 20211025
Update Code:: 20240104
DOI:: 10.1111/imj.15141
PMID:: 33314504
: Czasopismo naukowe

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Background: Because management is very different, it is important to differentiate between small focal insulinomas and diffuse pancreatic dysplasia (nesidioblastosis) in patients with confirmed endogenous hyperinsulinaemic hypoglycaemia (EHH). Most insulinomas highly express glucagon-like peptide-1 receptors enabling positron emission tomography-computed tomography imaging with its radiolabelled analogue; 68 Ga-DOTA-Exendin-4 (Exendin).
Aim: To determine: (i) the utility of Exendin in EHH patients in a clinical setting; and (ii) whether the degree of Exendin uptake differentiates non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) from post-gastric bypass hypoglycaemia (PGBH).
Methods: This retrospective study reviewed the clinical, biochemistry and prior imaging findings in confirmed EHH patients referred for Exendin. Accuracy of Exendin was based on surgical findings and treatment outcomes. Finally, average Exendin uptake (SUVmax) of five PGBH studies was compared with the SUVmax of a key NIPHS case report.
Results: Twenty of 25 consecutive patients had confirmed EHH. Exendin located insulinomas in eight of nine patients enabling successful surgical excision with rapid and durable cure. Exendin correctly identified diffuse nesidioblastosis in two of three cases requiring partial pancreatectomy for hypoglycaemia control. All three relapsed within 1.7 years with one needing completion pancreatectomy. Establishing the cause in the remainder relied on other investigations, clinical correlation and response to empirical treatment. Finally, Exendin SUVmax could not distinguish between NIPHS and PGBH.
Conclusion: In EHH patients, Exendin accurately identifies the site of insulinoma and thereby differentiates it from nesidioblastosis but negative findings should not be ignored. Exendin is unlikely to differentiate between normal pancreatic uptake, NIPHS and PGBH.
(© 2020 Royal Australasian College of Physicians.)

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Utility of 68 Ga-DOTA-Exendin-4 positron emission tomography-computed tomography imaging in distinguishing between insulinoma and nesidioblastosis in patients with confirmed endogenous hyperinsulinaemic hypoglycaemia.