False-positive In-111 DTPA octreotide scintigraphy in bilateral tibial insufficiency fracture

We present a case of bilateral tibial insufficiency fracture in which indium (In)-111 diethylenetriamine pentaacetic acid (DTPA) octreotide scan showed increased activity in the region of the fracture. The scan was performed in a 5-year-old girl with severe refractory hypertension and elevated plasma metanephrines for evaluation of possible neuroendocrine tumor. Octreotide scan is usually positive in neuroendocrine and some other tumors but also shows positive results in a number of other conditions. However insufficiency fracture has not been reported as a positive finding on octreotide scan in children. This may relate to the expression of somatostatin membrane receptor in activated white blood cells or expression of somatostatin receptors by bone cells.