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Objective: To study the ability of somatostatin receptor scintigraphy using Tc-99m-hydrazinonicotinyl-Tyr3-octreotide (Tc-99m-HYNIC-TOC) for localization of pancreatic neuroendocrine tumors. Methods: Five patients (3 female, 2 male; age range: 53 to 80 years; mean age: 65 years) with either histologically proven or clinically suspected insulinoma were studied. Ten mCi of Tc-99m-HYNIC-TOC were intravenously injected. Whole body scans were obtained 2 and 4 hours after injection. SPECT/CT studies of areas of interest were performed after the 4-hour whole body image. Scintigraphic findings were correlated not only with the results of conventional imaging methods, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound but also through 1-year clinical follow-up. Results: The Tc-99m-HYNIC-TOC study showed true-negatives in two patients suspected of insulinoma proven by intraoperative ultrasound in one case and 1-year clinical follow-up with no evidence of hypoglycemia in the other patient. Abnormal Tc-99m-HYNIC-TOC accumulation was demonstrated in three patients with pancreatic tumors. Additional metastatic lesions to lung and bone were detected in one patient formerly diagnosed of malignant insulinoma with multiple liver metastases. Conclusion: Tc-99m-HYNIC-TOC SPECT/CT imaging may provide more accurate staging of pancreatic neuroendocrine tumors than conventional imaging. It is an optional technique to recruit patients for somatostatin analogs therapy.

Objective: 1) To characterize clinical presentations of craniophryngioma in the hypothalamic- pituitary region 2) To examine both pre-treatment and post-treatment endocrine dysfunction of patients with craniopharyngioma. Methods: Medical records of patients with craniopharyngiomas from the Endocrine Division, Department of Medicine from 1997 to 2005 (9 years) were retrospectively reviewed. Data were expressed as mean ± SD (range) or percent as appropriate. Results: There were 14 cases (7 males and 7 females) with histological-proven diagnosis of craniopharyngioma. Their mean age was 32.3 ± 13.0 years (15-56). The major distinguishing feature leading to diagnosis was visual field defects (85.7%), and a quarter of them were blind. Other distinguishing symptoms were headaches (78.6%), and menstrual disorders (28.6%). Pre-operative evaluations of their pituitary function revealed hypogonadotropic hypogonadism (55.6%), diabetes insipidus (DI) (42.9%), secondary adrenal insufficiency (18%) and elevated prolactin levels (36.4%) with a mean level of 36.1 ± 39.2 ng/ml (12-138). All tumors were confirmed by pituitary CT or MRI. Mean tumor size was 3.83 ± 1.3 cm. (2-6), and hydrocephalus was found in 54.5% of all patients. Craniotomy was performed in 13 cases with one transphenoidal surgery. Post-operative endocrine evaluations revealed more frequent hypogonadotropic hypogonadism (90%), both secondary adrenal insufficiency and diabetes insipidus (85.7%). 50% of DI cases were permanent DI. Secondary hypothyroidism was found post-operatively (78%). All cases of elevated serum prolactin levels became normal post-operatively and 44% of all patients had visual field improvement within a follow up period of 2.1 ± 2.3 years (0-7). Conclusion: Craniopharyngioma is associated with high morbidity pre and post-operation. Visual field tests should be carefully evaluated in all patients with headaches to make early diagnosis in order to improve the treatment outcome.