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Endocrine Abstracts (2015) 37 GP28.03 | DOI: 10.1530/endoabs.37.GP.28.03

1Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland; 2Department of Pathology, Jagiellonian University Medical College, Krakow, Poland; 3Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; 4Department of Endocrinology, Medical University of Warsaw, Warsaw, Poland; 5Department of Endocrinology and Radioisotopic Therapy, Military Institute of Medicine, Warsaw, Poland; 6Department of Endocrinology and Nuclear Medicine, Holycross Cancer Center, Kielce, Poland; 7Radioisotope Center POLATOM, National Centre for Nuclear Research, Otwock, Poland.


Surgery is the only effective therapy for insulinoma patients, therefore there is a necessity to develop diagnostic strategies in cases of unknown tumour location, possibly through the use of new biomarkers. 99mTc labelled glucagon-like peptide 1 analogue (99mTc-GLP1) scintigraphy has been developed in our centre as an imaging technique of insulinoma. Labelled GLP1 analogue might also be applied in diagnosis of various forms of nesidioblastosis allowing to determine the range of surgery in its focal and diffuse types, if suitable.

Material and methods: Study included: 40 patients with suspected insulinoma in whom CT/MR/EUS/SRS failed to visualise tumour thus excluding surgical intervention, 3patients with malignant insulinoma and three with nesidioblastosis (to assess its type form). (Lys40(Ahx-HYNIC-99mTc/EDDA)NH2)exendin-4-SPECT/CT with volumetric analysis was performed.

Results: 21/40 cases were true positive with focal tracer uptake in pancreas including histopathologically confirmed bifocal insulinoma. In all operated patients symptoms resolved postsurgically. One false negative result appeared to be malignant insulinoma, in one no tumour was found (false positive result). Nine cases were true negative with no 99mTc-GLP1 uptake (reactive hypoglycemia or Munchausen syndrome); eight patients were lost from follow up. Sensitivity, specificity, PPV of 99mTc-GLP1-SPECT/CT were 95, 90, and 95% respectively. Scintigraphy revealed diffuse tracer uptake in two, and a focal lesion in one nesidioblastosis patients (histopathology: coexistent nesidioblastosis and insulinoma). 99mTc-GLP1–SPECT/CT confirmed different biology of primary tumour (PT) and metastases in malignant insulinoma (phenomenon well known in NENs): both PT and metastases were negative in one patient, PT positive and metastases negative in 1, PT negative and metastases positive in last case.

Conclusions: In our study 99mTc-GLP1–SPECT/CT proved to be helpful in management of persistent hypoglycaemia patients. 99mTc-GLP1–SPECT/CT could also be considered in the former stages of diagnostic schemes to optimise the procedures with a more effective strategy to allow sparing operation as well as to improve the quality of life of these patients.

Disclosure: This study was supported by the Polish Ministry of Science within Research project number N402 445039.

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