A Case Report: Insulinoma in a Military Pilot Detected by 68Ga-Dotatate PET/CT

Abstract A 37-year-old active duty male Air Force instructor pilot, with no prior medical history, was found unresponsive at his home after awakening with symptoms of altered mental status when the Emergency Medical Service (EMS) was called. The patient was found to be hypoglycemic with a glucose of 37 mg/dL. The patient recovered after administration of a dextrose bolus. Further investigation revealed that over the last several years, the patient exhibited symptoms of lightheadedness and tremors if fasted greater than 3 hours. Further clinical workup strongly suggested the presence of a neuroendocrine tumor. Initial imaging studies to include a multiphasic dedicated pancreatic computed tomography (CT) scan did not demonstrate a pancreatic lesion. However, the utilization of an innovative new nuclear medicine imaging modality, a 68Ga-Dotatate PET/CT, clearly demonstrated a 19 × 16 mm lesion of the distal pancreatic tail, which guided surgical resection. He underwent a robotic-assisted laparoscopic distal pancreatectomy, pathologically characterized as an insulinoma. The patient’s symptoms immediately resolved with no recurrence over the next 6 months. The pilot was granted a waiver, returning him to his flying duties. The 68Ga-Dotatate PET/CT enabled the identification of an otherwise occult pancreatic neuroendocrine tumor ultimately leading to this patient’s definitive cure and the salvage of this military asset’s aviation career.

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Ectopic corticotropin-releasing hormone syndrome caused by pancreatic neuroendocrine tumor localized by 68Ga-DOTATATE PET/CT

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-018-4228-4 ◽

2018 ◽

Vol 46 (3) ◽

pp. 788-788 ◽

Cited By ~ 2

Author(s):

Guozhu Hou ◽

Yuanyuan Jiang ◽

Wuying Cheng

Keyword(s):

Neuroendocrine Tumor ◽

Pancreatic Neuroendocrine Tumor ◽

Corticotropin Releasing Hormone ◽

Releasing Hormone ◽

Pet Ct

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Laparoscopic Distal Pancreatectomy for an ACTH Secreting Pancreatic Neuroendocrine Tumor

VideoEndocrinology ◽

10.1089/ve.2015.0049 ◽

2015 ◽

Vol 2 (4) ◽

Cited By ~ 3

Author(s):

Camille L. Stewart ◽

Christopher Raeburn ◽

Barish H. Edil

Keyword(s):

Neuroendocrine Tumor ◽

Distal Pancreatectomy ◽

Pancreatic Neuroendocrine Tumor ◽

Laparoscopic Distal Pancreatectomy ◽

Acth Secreting

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Impact of initial imaging with gallium-68 dotatate PET/CT on diagnosis and management of patients with neuroendocrine tumors (NETs): A sequential case series.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.379 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 379-379

Author(s):

Hagen F. Kennecke ◽

Preethi Raghu ◽

Bruce Lin ◽

Gayle L. Funk ◽

Adnan Alseidi ◽

...

Keyword(s):

Metastatic Disease ◽

Imaging Modality ◽

Case Series ◽

Lesion Detection ◽

Unknown Primary ◽

Somatostatin Analogue ◽

Diagnosis And Management ◽

Pet Ct ◽

Initial Imaging ◽

The Impact

379 Background: Somatostatin analogue functional imaging with Ga-68 Dotatate PET/CT has demonstrated superiority in lesion detection in patients with NETs. The effect of this novel imaging modality on US clinical practice and its usefulness in different types of NETs is not well described. We describe the impact of initial NETSPOT imaging on diagnosis and management in NET patients at a large urban medical center. Methods: Consecutive patients diagnosed with NETs and referred to our institution who received an initial Ga-68 Dotatate PET/CT between 07/2017-09/2018 were included. Imaging was reviewed and compared to prior available CT, MRI, and/or In-111 Pentetreotide scans. Results: Among 101 patients, 51/50 were female/male, tumor origins were gastroenteropancreatic (GEP) (75%), Unknown Primary (UP) (13%), lung (8%), thymic (2%), and other (2%). All tumors were histologically well/moderately differentiated and 37/51/3/10 were G1/G2/G3/Unknown, respectively. Initial imaging with Ga-68 Dotatate PET/CT revealed additional metastatic disease in 37 of 77(48%) patients with prior evidence of metastatic disease. Most common sites were distant lymph nodes (18), bone (15) and liver (9), peritoneal/pleural (4). A previously UP tumor was identified in 3 patients. No patients with metastatic lung carcinoids (6 atypical, 2 typical) or thymic NETs (2 atypical/G2) NETs had evidence of Ga-68 Dota PET/CT uptake above reference liver SUV levels. Results of imaging altered patient management as follows: 14 initiated systemic therapy due to documentation of progression, in 6 surgical therapy was altered, in 4 biopsy/other management was changed. In 11 patients with no tumor Ga-68 Dotatate uptake, decisions about use of PRRT and somatostatin analogues was altered. Conclusions: In this series, Ga-68 Dotatate PET/CT altered diagnosis and management in 35/101 NET patients. Among GEP and UP NETs, Dotatate imaging diagnosed primarily new nodal, bone, liver and pleural/peritoneal metastases missed by other imaging modalities. Results support the routine use of Ga-68 Dotatate PET/CT in the care of patients with advanced and early stage NETS.

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