{
  "abstract": "Background\n\nLocalization of recurrent or residual insulinoma may be particularly challenging in postoperative setting, especially in the presence of postoperative anatomical distortion and inconclusive conventional imaging.Case presentation\n\nA 71-year-old man developed recurrent endogenous hyperinsulinemic hypoglycemia following apparently curative surgical enucleation of a pancreatic insulinoma. The postoperative course was complicated by intra-abdominal hemorrhage and pseudocyst formation, resulting in marked anatomical distortion. Despite persistent biochemical evidence of insulinoma recurrence, serial contrast-enhanced computed tomography (CT) and ⁶⁸Ga-DOTATOC PET/CT failed to identify residual disease. Subsequent glucagon-like peptide-1 receptor (GLP-1R) imaging with ⁶⁸Ga-NODAGA-Exendin-4 PET/CT demonstrated focal tracer uptake in the pancreatic head, highly suggestive of recurrent or residual insulinoma. Endoscopic ultrasound (EUS) subsequently confirmed a small lesion in the uncinate process, which was successfully treated with EUS-guided radiofrequency ablation (EUS-RFA). Following the procedure, hypoglycemic episodes resolved, with normalization of glucose, insulin, and C-peptide levels and no signs of recurrence at follow-up.Conclusion\n\nThis case highlights the clinical value of GLP-1 receptor PET/CT for localizing insulinoma in the context of negative conventional or somatostatin receptor (SSTR)-based imaging. Accurate functional localization may directly guide minimally invasive therapeutic interventions and help avoid high-risk reoperative pancreatic surgery.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine and Surgery University of Parma Parma Italy unipr.it.",
    "Nuclear Medicine Division University Hospital of Parma Parma Italy parmahospital.org.",
    "Endocrinology and Metabolic Diseases Azienda Ospedaliero-Universitaria of Parma Parma Italy unipr.it.",
    "Endocrinology, Diabetes and Metabolism Department of Medicine University and Hospital Trust of Verona Verona Italy ospedaleuniverona.it."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Lorenzo Taglia",
      "orcid": "0009-0006-8027-4520"
    },
    {
      "affs": [
        1
      ],
      "name": "Alessandra Guercio",
      "orcid": "0009-0003-6913-8331"
    },
    {
      "affs": [
        1
      ],
      "name": "Silvia Migliari",
      "orcid": "0000-0002-2082-773X"
    },
    {
      "affs": [
        2
      ],
      "name": "Angela Vazzana"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Riccardo C Bonadonna",
      "orcid": "0000-0002-9809-1005"
    },
    {
      "affs": [
        1
      ],
      "name": "Livia Ruffini",
      "orcid": "0000-0002-4398-8368"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Alessandra Dei Cas",
      "orcid": "0000-0002-8666-4849"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fasvrc4q2dx6b.bib",
  "cited_by": 0,
  "doi": "10.1155/crie/7874466",
  "fulltext_url": "https://europepmc.org/articles/PMC13647209",
  "id": "fasvrc4q2dx6b",
  "issns": [
    "2090-6501",
    "2090-651X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42852102",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Neuroendocrine Tumor Research Advances"
    ]
  ],
  "openalex": "W7220963114",
  "pdf_url": "https://europepmc.org/articles/PMC13647209?pdf=render",
  "pmcid": "PMC13647209",
  "pmid": "42852102",
  "published": "2026-10-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fasvrc4q2dx6b.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:02Z",
      "native_id": "MED:42852102",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42852102"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Neuroendocrine Tumor Research Advances",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Persistent Hyperinsulinemic Hypoglycemia After Insulinoma Surgery: Diagnostic Impact of GLP-1 Receptor PET/CT After Negative Conventional Imaging.",
  "title_text": "Persistent Hyperinsulinemic Hypoglycemia After Insulinoma Surgery: Diagnostic Impact of GLP-1 Receptor PET/CT After Negative Conventional Imaging.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
  "url": "https://research.draconitic.com/paper/fasvrc4q2dx6b",
  "venue": "Case reports in endocrinology",
  "versions": []
}