Pancreatic Imaging

Insulinoma Identified in Puerperium: Association with Pregnancy and Literature Review

Postpartum hypoglycemia in non-diabetic women is a rare condition. We report the case of a 34-year-old woman who experienced neuroglycopenia 2 days after delivery. Corresponding to severe hypoglycemia, we found inappropriately elevated insulin and C-peptide levels. Following magnetic resonance imaging a lesion of 10×8 mm was detected in the head of the pancreas. An ultrasound-guided fine needle aspiration of the mass confirmed the diagnostic suspicion of a pancreatic neuroendocrine tumor. Complete surgical enucleation of the insulinoma resulted in immediate and permanent resolution of the hypoglycemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with insulinoma. The diagnostic approach to postpartum hypoglycemia represents a challenge for multidisciplinary teamwork.

Surgical resection of pancreatic insulinoma during pregnancy: Case report and literature review

INTRODUCTION

Insulinomas are neuroendocrine tumors characterized by an excessive secretion of insulin, and its most common primary site is the pancreas.

PRESENTATION OF THE CASE

Female, 31 years old, who underwent surgical resection of a pancreatic insulinoma measuring 0.5 × 0.5 cm during the third trimester of pregnancy. The patient started to present characteristic symptoms (hypoglycemia, adrenergic and neuroglycopenic symptoms) 18 months before being referred to our center. It was decided to resect the lesion due to the intensity of the symptoms and failure of the clinical treatment. The postoperative course was uneventful, and the fetus presented good vitality, as evidenced by the obstetric ultrasound. The patient was discharged from the hospital on the 6th postoperative day. The neonate was born at term, 38 weeks, with appropriate weight for gestational age. Today, around 12 months after surgery, the patient and the infant are in good health conditions and have no complaints.

CONCLUSION

The moment of the surgical intervention in our case reflects the importance of this report, since it reinforces the feasibility of this procedure during pregnancy.

Diagnostic challenges in a patient with an occult insulinoma:68 Ga-DOTA-exendin-4 PET/CT and 68Ga-DOTATATE PET/CT

Despite growing evidence for GLP-1R molecular-based imaging, successful localization of insulinomas may require the use of multiple imaging modalities. Not all benign insulinomas express the GLP-1R as expected. Our case demonstrates that there is a still an important role for traditional methods for the anatomical localization of an insulinoma.