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Detection of Metastatic Insulinoma with 68Ga-NODAGA-Exendin-4 PET/CT in a Young Child – A Case Report


Introduction: Malignant insulinomas are extremely rare in children. Localizing metastases of insulinoma is challenging. Imaging modalities like CT and MRI show limited results. Somatostatin-receptor (SSTR) imaging (SRS) performs better. However, a subgroup of malignant insulinoma lack SSRT-2 and can, therefore, not be localized using SRS. We propose that in these cases GLP-1R imaging, using the stable GLP-1 analog exendin, could play an important role.

Aim(s): We here report a rare case of an 11-year old boy with malignant insulinoma, which shows the diagnostic relevance of GLP-1R PET/CT.

Materials and methods: An 11-year old boy presented with recurrent hypoglycemia after pancreatectomy. Metastases of the insulinoma were suspected. MRI and CT showed multiple lesions diffuse in the liver, suggestive of steatosis. The presence of insulinoma metastases could not be confirmed. 68Ga-DOTATATE PET/CT did not show pathological accumulation in the liver. We performed a 68Ga-NODAGA-exendin-4 PET/CT 4 years after the initial operation.

Conference: 14th Annual ENETSConcerence (2017)

Presenting Author: Boss M

Authors: Boss M, de Herder W, Hussain K, Shah P, Brom M,

Keywords: Metastatic insulinoma, GLP-1R, PET, exendin,

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