Aggressive Metastatic Insulinoma in a Patient of Diabetes Mellitus with Documentation on Dual-Tracer PET-CT ([68Ga]Ga-DOTATATE and [18F]FDG): Clinical Benefits with Combined Chemo-PRRT Approach

IF 0.6 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING World Journal of Nuclear Medicine Pub Date : 2024-07-24 DOI:10.1055/s-0044-1788735
Yeshwanth Edamadaka, R. Parghane, Sandip Basu
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Abstract

Insulinoma is a relatively uncommon pancreatic neuroendocrine tumor, with approximately 10% of the cases being malignant. Diabetes mellitus (DM) with concurrent insulinoma is very rare and the diagnosis of such condition is easily missed as it can be misconstrued as improved glycemic control. Therefore, persistent hypoglycemic symptoms even after stopping antidiabetic medications may be considered for insulinoma. Herein, we present a patient with DM and pancreatic insulinoma with extensive hepatic and skeletal metastases on dual-tracer positron emission tomography/computed tomography (PET/CT) ([68Ga]Ga-DOTATATE and [18F]fluorodeoxyglucose). Given the extensive disease, the patient was treated with a combination of peptide receptor radionuclide therapy (PRRT) and chemotherapy (capecitabine and temozolomide). During therapy, patient showed early clinical and imaging response for insulinoma leading to unmasking of poor glycemic control necessitating requirement of insulin administration for DM. The patient did not experience any life-threatening hypoglycemia during the chemo-PRRT treatment and showed an improvement in quality of life. Unfortunately, the disease progressed at the 4th cycle, 10 months after the initiation of PRRT. We conclude that combined chemo-PRRT may be considered an effective treatment option for patients with metastatic insulinoma and DM owing to its favorable imaging response and effective symptom control.
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双示踪 PET-CT ([68Ga]Ga-DOTATATE 和 [18F]FDG)记录的糖尿病患者的侵袭性转移性胰岛素瘤:化疗-PRRT联合疗法的临床疗效
胰岛素瘤是一种比较少见的胰腺神经内分泌肿瘤,约有10%的病例为恶性。糖尿病(DM)并发胰岛素瘤的情况非常罕见,这种情况很容易被误认为是血糖控制得到改善而漏诊。因此,停用抗糖尿病药物后仍持续出现低血糖症状的患者应考虑胰岛素瘤。在此,我们介绍一位患有糖尿病和胰岛素瘤的患者,该患者的双示踪剂正电子发射断层扫描/计算机断层扫描(PET/CT)([68Ga]Ga-DOTATATE 和[18F]氟脱氧葡萄糖)显示其存在广泛的肝脏和骨骼转移。鉴于疾病范围广泛,患者接受了肽受体放射性核素疗法(PRRT)和化疗(卡培他滨和替莫唑胺)联合治疗。在治疗期间,患者出现了胰岛素瘤的早期临床和影像学反应,导致血糖控制不佳,必须使用胰岛素治疗糖尿病。在化疗-PRRT治疗期间,患者没有出现任何危及生命的低血糖症状,生活质量也有所改善。不幸的是,在 PRRT 治疗开始 10 个月后的第 4 个周期,病情出现了进展。我们的结论是,化疗-PRRT联合疗法因其良好的影像学反应和有效的症状控制,可被视为转移性胰岛素瘤合并DM患者的有效治疗方案。
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来源期刊
World Journal of Nuclear Medicine
World Journal of Nuclear Medicine RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
自引率
16.70%
发文量
118
审稿时长
48 weeks
期刊最新文献
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