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1. 99mTc Labeled Glucagon-Like Peptide-1-Analogue (99mTc-GLP1) Scintigraphy in the Management of Patients with Occult Insulinoma.

Author

Anna Sowa-Staszczak, Małgorzata Trofimiuk-Müldner, Agnieszka Stefańska, Monika Tomaszuk, Monika Buziak-Bereza, Aleksandra Gilis-Januszewska, Agata Jabrocka-Hybel, Bogusław Głowa, Maciej Małecki, Tomasz Bednarczuk, Grzegorz Kamiński, Aldona Kowalska, Renata Mikołajczak, Barbara Janota, and Alicja Hubalewska-Dydejczyk

Subjects
Medicine, Science
Abstract

The aim of this study was to assess the utility of [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 scintigraphy in the management of patients with hypoglycemia, particularly in the detection of occult insulinoma.Forty patients with hypoglycemia and increased/confusing results of serum insulin and C-peptide concentration and negative/inconclusive results of other imaging examinations were enrolled in the study. In all patients GLP-1 receptor imaging was performed to localise potential pancreatic lesions.Positive results of GLP-1 scintigraphy were observed in 28 patients. In 18 patients postsurgical histopathological examination confirmed diagnosis of insulinoma. Two patients had contraindications to the surgery, one patient did not want to be operated. One patient, who presented with postprandial hypoglycemia, with positive result of GLP-1 imaging was not qualified for surgery and is in the observational group. Eight patients were lost for follow up, among them 6 patients with positive GLP-1 scintigraphy result. One patient with negative scintigraphy was diagnosed with malignant insulinoma. In two patients with negative scintigraphy Munchausen syndrome was diagnosed (patients were taking insulin). Other seven patients with negative results of 99mTcGLP-1 scintigraphy and postprandial hypoglycemia with C-peptide and insulin levels within the limits of normal ranges are in the observational group. We would like to mention that 99mTc-GLP1-SPECT/CT was also performed in 3 pts with nesidioblastosis (revealing diffuse tracer uptake in two and a focal lesion in one case) and in two patients with malignant insulinoma (with the a focal uptake in the localization of a removed pancreatic headin one case and negative GLP-1 1 scintigraphy in the other patient).99mTc-GLP1-SPECT/CT could be helpful examination in the management of patients with hypoglycemia enabling proper localization of the pancreatic lesion and effective surgical treatment. This imaging technique may eliminate the need to perform invasive procedures in case of occult insulinoma.

Published
2016
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2. 99mTc Labeled Glucagon-Like Peptide-1-Analogue (99mTc-GLP1) Scintigraphy in the Management of Patients with Occult Insulinoma

Author

Tomasz Bednarczuk, Barbara Janota, Aldona Kowalska, Monika Tomaszuk, Bogusław Głowa, Malgorzata Trofimiuk-Muldner, Maciej T. Malecki, Aleksandra Gilis-Januszewska, Agata Jabrocka-Hybel, Anna Sowa-Staszczak, Agnieszka Stefańska, Grzegorz Kamiński, Renata Mikolajczak, Monika Buziak-Bereza, and Alicja Hubalewska-Dydejczyk

Subjects
Blood Glucose, Male, endocrine system diseases, Cancer Treatment, lcsh:Medicine, Pathology and Laboratory Medicine, Scintigraphy, Biochemistry, Gastroenterology, Diagnostic Radiology, Endocrinology, 0302 clinical medicine, Glucagon-Like Peptide 1, Medicine and Health Sciences, Insulin, Medicine, Radionuclide imaging, Endocrine Tumors, lcsh:Science, Tomography, Multidisciplinary, medicine.diagnostic_test, Radiology and Imaging, Organotechnetium Compounds, Middle Aged, Magnetic Resonance Imaging, Glucagon-like peptide-1, Surgical Oncology, Oncology, Isotope Labeling, 030220 oncology & carcinogenesis, Female, hormones, hormone substitutes, and hormone antagonists, Research Article, medicine.drug, Adult, Clinical Oncology, endocrine system, medicine.medical_specialty, Adolescent, Imaging Techniques, Surgical and Invasive Medical Procedures, Neuroimaging, 030209 endocrinology & metabolism, Hypoglycemia, Research and Analysis Methods, Young Adult, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, Internal medicine, Humans, Radionuclide Imaging, Insulinoma, Aged, Diabetic Endocrinology, Venoms, business.industry, lcsh:R, Cancers and Neoplasms, Biology and Life Sciences, medicine.disease, Occult, Hormones, Computed Axial Tomography, Metabolic Disorders, Lesions, Exenatide, lcsh:Q, Clinical Medicine, Peptides, business, Neuroscience
Abstract

Introduction The aim of this study was to assess the utility of [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 scintigraphy in the management of patients with hypoglycemia, particularly in the detection of occult insulinoma. Materials and Methods Forty patients with hypoglycemia and increased/confusing results of serum insulin and C-peptide concentration and negative/inconclusive results of other imaging examinations were enrolled in the study. In all patients GLP-1 receptor imaging was performed to localise potential pancreatic lesions. Results Positive results of GLP-1 scintigraphy were observed in 28 patients. In 18 patients postsurgical histopathological examination confirmed diagnosis of insulinoma. Two patients had contraindications to the surgery, one patient did not want to be operated. One patient, who presented with postprandial hypoglycemia, with positive result of GLP-1 imaging was not qualified for surgery and is in the observational group. Eight patients were lost for follow up, among them 6 patients with positive GLP-1 scintigraphy result. One patient with negative scintigraphy was diagnosed with malignant insulinoma. In two patients with negative scintigraphy Munchausen syndrome was diagnosed (patients were taking insulin). Other seven patients with negative results of 99mTcGLP-1 scintigraphy and postprandial hypoglycemia with C-peptide and insulin levels within the limits of normal ranges are in the observational group. We would like to mention that 99mTc-GLP1-SPECT/CT was also performed in 3 pts with nesidioblastosis (revealing diffuse tracer uptake in two and a focal lesion in one case) and in two patients with malignant insulinoma (with the a focal uptake in the localization of a removed pancreatic headin one case and negative GLP-1 1 scintigraphy in the other patient). Conclusions 99mTc-GLP1-SPECT/CT could be helpful examination in the management of patients with hypoglycemia enabling proper localization of the pancreatic lesion and effective surgical treatment. This imaging technique may eliminate the need to perform invasive procedures in case of occult insulinoma.

Published
2016

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