Persistent Hyperinsulinemic Hypoglycemia After Insulinoma Surgery: Diagnostic Impact of GLP-1 Receptor PET/CT After Negative Conventional Imaging.
4 affiliations
- 1Department of Medicine and Surgery University of Parma Parma Italy unipr.it.
- 2Nuclear Medicine Division University Hospital of Parma Parma Italy parmahospital.org.
- 3Endocrinology and Metabolic Diseases Azienda Ospedaliero-Universitaria of Parma Parma Italy unipr.it.
- 4Endocrinology, Diabetes and Metabolism Department of Medicine University and Hospital Trust of Verona Verona Italy ospedaleuniverona.it.
Abstract
Background
Localization 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
A 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
This 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.
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BibTeX
@article{taglia2026persistent,
title = {{Persistent Hyperinsulinemic Hypoglycemia After Insulinoma Surgery: Diagnostic Impact of GLP-1 Receptor PET/CT After Negative Conventional Imaging.}},
author = {Lorenzo Taglia and Alessandra Guercio and Silvia Migliari and Angela Vazzana and Riccardo C Bonadonna and Livia Ruffini and Alessandra Dei Cas},
journal = {Case reports in endocrinology},
year = {2026},
month = oct,
doi = {10.1155/crie/7874466},
url = {https://europepmc.org/article/MED/42852102},
note = {CC BY},
}
RIS
TY - JOUR
TI - Persistent Hyperinsulinemic Hypoglycemia After Insulinoma Surgery: Diagnostic Impact of GLP-1 Receptor PET/CT After Negative Conventional Imaging.
AU - Lorenzo Taglia
AU - Alessandra Guercio
AU - Silvia Migliari
AU - Angela Vazzana
AU - Riccardo C Bonadonna
AU - Livia Ruffini
AU - Alessandra Dei Cas
PY - 2026
DA - 2026/10/08
JO - Case reports in endocrinology
DO - 10.1155/crie/7874466
UR - https://europepmc.org/article/MED/42852102
AB - Background Localization 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 A 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 This 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.
SN - 2090-6501
SN - 2090-651X
ER -