Related Experiment Video
Updated: Jun 3, 2025
00:05
Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
8.1K
Insulinoma With Ambiguous Biochemistry, Positive 68Ga-DOTA-Exendin-4 PET-CT, and Effective Endoscopic Ablation
Fernando Jia Jing Loo1, Melvin Kok Seng Lee2, Hian Liang Huang3
1Department of Endocrinology, Tan Tock Seng Hospital, Singapore 308433.
JCEM Case Reports
|January 10, 2025
Summary
This study highlights a novel approach to diagnosing insulinoma in a elderly patient. Functional imaging and endoscopic ultrasound-guided radiofrequency ablation proved effective when traditional methods were inconclusive.
Area of Science:
- Endocrinology
- Oncology
- Gastroenterology
Background:
- A 75-year-old female presented with recurrent episodes of fasting hypoglycemia, a hallmark of insulinoma.
- Initial diagnostic workup, including a supervised fast and imaging, yielded equivocal results, complicating the diagnosis.
Observation:
- Despite suppressed insulin and C-peptide levels, discordant suppression of serum β-hydroxybutyrate was noted.
- Computed tomography revealed a pancreatic head nodule, but cytology and biopsy were inconclusive.
- 68Gallium-DOTA-exendin-4 positron emission tomography CT successfully localized a single insulinoma in the pancreatic head.
Findings:
- 68Gallium-DOTA-exendin-4 PET/CT is a valuable tool for diagnosing and localizing insulinoma, especially when other methods fail.
- Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) provided an effective alternative to surgery for this elderly patient.
Implications:
- This case demonstrates the utility of advanced functional imaging in challenging insulinoma cases.
- EUS-RFA offers a minimally invasive and effective treatment option for insulinoma in frail or elderly patients unsuitable for surgery.
