Preoperative localization of adult nesidioblastosis using 68Ga-DOTA-exendin-4-PET/CT
- 392 Downloads
The term “nesidioblastosis” has been used to denote histopathological findings such as neogenesis from pancreatic ductal epithelium in parallel with β-cell hyperplasia and hypertrophy (1). This entity was first described in children and neonates and is characterized by endogenous hyperinsulinemic hypoglycemia. The incidence rate in adults ranges between 0.5 and 7 %. The pathophysiological mechanisms in adults are ill-defined.
The preoperative distinction between insulinoma and nesidioblastosis is of primordial importance since the therapeutical strategies are different, ranging from a enucleation in the case of insulinoma up to a 70–80 % pancreatectomy in the case of nesidioblastosis. Clinically, the distinction between insulinoma and nesidioblastosis is not always possible.
Preoperative imaging including MRI, CT, and endosonography is not diagnostic in adult nesidioblastosis, and invasive investigation using selective arterial calcium stimulation and venous sampling (ASVS) is...
KeywordsInsulinoma Normal Pancreas Hyperinsulinemic Hypoglycemia Pancreatic Ductal Epithelium Normal Acinus
We thank Thomas Pfammatter, University Hospital of Zurich, for performing ASVS testing and Daniela Biondo, Mia Nagy, Svenja Scheiwiller, Franziska Hofer, and Andrea Popescu (University of Basel Hospital) for excellent technical assistance in carrying out GLP-1R imaging. This work was supported in part by the Swiss National Science Foundation Grant No. 320030_152938/1 (to E.C., D.W. and M.F.) and the Desirée and Niels Yde’s Foundation Grant No, 389-12 (to D.W.).
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.M. Anlauf, D. Wieben, A. Perren, B. Sipos, P. Komminoth, A. Raffel, M.L. Kruse, C. Fottner, W.T. Knoefel, H. Monig, P.U. Heitz, G. Kloppel, Persistent hyperinsulinemic hypoglycemia in 15 adults with diffuse nesidioblastosis: diagnostic criteria, incidence, and characterization of beta-cell changes. Am. J. Surg. Pathol. 29, 524–533 (2005)CrossRefPubMedGoogle Scholar
- 2.E. Christ, D. Wild, S. Ederer, M. Béhé, G. Nicolas, M. Caplin, M. Brändle, T. Clerici, S. Fischli, C. Stettler, P. Ell, J. Seufert, B. Gloor, A. Perren, J.C. Reubi, F. Forrer, Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: a prospective multicentre imaging study. Lancet Diabetes Endocrinol 1, 115–122 (2013)CrossRefPubMedGoogle Scholar