ECEESPE2025 Oral Communications Oral Communications 8: Diabetes and Insulin Part 2 (6 abstracts)
Ga-Exendin-4-guided surgery in children with congenital hyperinsulinism (CHI)
Laurina Bühner 1 , Karin Rothe 2 , Kathrin Hauptmann 3 , Marti Boss 4 , Nicola Beindorff 5 , Martin Gotthardt 6 , Steven Warmann 2 , Winfried Brenner 7 , Paniz Akbarzadeh Taghavi 7 , Julian Rogasch 7 , Oliver Blankenstein 1 , Peter Kühnen 1 & Vikas Prasad 8
1Charité Universitätsmedizin Berlin, Department of Pediatric Endocrinology and Diabetology, Berlin, Germany; 2Charité Universitätsmedizin Berlin, Department of Pediatric Surgery, Berlin, Germany; 3Charité Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany; 4Radboud University Medical Center, Department of Medical Imaging, Nijmegen, Netherlands; 5Charité Universitätsmedizin Berlin, Berlin Experimental Radionuclide Imaging Center – BERIC, Berlin, Germany; 6Radboud University Medical Center, Department of Radiology, Nijmegen, Netherlands; 7Charité Universitätsmedizin Berlin, Department of Nuclear Medicine, Berlin, Germany; 8Washington University St. Louis, Division of Nuclear Medicine, St. Louis, United States
JOINT45968
Congenital hyperinsulinism (CHI) is a critical condition predominantly manifesting in neonates through severe hypoglycemic episodes. This can lead to severe brain damage and retardation of cognitive development if not detected and treated in time. Importantly, CHI is differentiated into focal and diffuse forms based on the distribution of affected pancreatic beta cells. Focal CHI typically arises from a paternally inherited heterozygous mutation in the ATP-sensitive potassium channel (ABCC8, KCNJ11) and can be identified by 18F-DOPA or 68Ga-Exendin-4 PET scan. However, intra-operative localization of focal CHI remained challenging until recently. This proof-of-concept study expands on previous work investigating the suitability of 68Ga-Exendin-4, a GLP-1 receptor-binding tracer, as a diagnostic tool and as a tracer for radio-guided surgery to improve preciseness of intraoperative detection and resection of focal CHI lesions1. We describe a cohort of 27 patients with CHI. Preoperative imaging included 18F-DOPA CT and 68Ga-Exendin-4 PET MRI scans. During surgery, approx. 45 MBq of 68Ga-Exendin-4 were administered intravenously. Beginning one minute after tracer application a handheld, cable-free positron probe was used at intervals of one minute to five minutes to intraoperatively locate the lesion by detecting positron emissions from the radiotracer. In 26 out of 27 cases, it was possible using 68Ga-Exendin-4 to identify the CHI focus localization correctly. Additionally, the radio-guided surgery approach successfully facilitated the identification and resection of focal CHI lesions in 23 of 27 cases. Except for a significant increase in heart rate 1 min (mean=125±18/min vs. 139±20/min, P<0.001) and 30 min (mean=141±19/min, P<0.001) after the administration of 68Ga-Exendin-4, no adverse effects were observed. We compared the data with 12 patients with CHI, which were operated on without radio-guidance. The radio-guided approach reduced time of surgery (mean=343±83 min vs. 280±107 min), though the difference was not statistically significant (P=0.072), while also minimizing surgical complications (58.3% vs. 20%, P<0,05). In conclusion this study confirms the efficacy of 68Ga-Exendin-4 as both a diagnostic and intraoperative tool for focal CHI. Radio-guided surgery using 68Ga-Exendin-4 improves lesion localization and reduces operative time, offering a promising advancement in the management of focal CHI.
References: 1. Kühnen P, Prasad V, Rothe K, et al. 68Ga-labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism: Proof of concept. Submitted.
Volume 110
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Endocrine Abstracts
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