PDF(Pubmed)
Abstract：
Nesidioblastosis is a rare cause of hyperinsulinemic hypoglycemia in adults and its clinical features are similar to those of insulinoma with recurrent hypoglycemic attacks. The present study reports the case of a 48-year-old man who visited the Affiliated Hospital of Zunyi Medical University (Zunyi, China) with a 5-year history of recurrent hypoglycemic symptoms such as dizziness and palpitations. Abdominal magnetic resonance imaging (MRI) showed a mass of ~1.2x1.0 cm in the head of the pancreas, which was suspected to be an insulinoma. For confirmation, the patient underwent both fluorine-18-fluorodeoxyglucose (18F-FDG) and gallium-68-labeled 1,4,7,10-tetraazacyclododecane-1,4,7,10-teraacetic acid-d-Phel-Tyr3-Thr8-OC (68Ga-DOTATATE) positron emission tomography/computed tomography (PET/CT), which showed a moderately increased uptake of 18F-FDG but no uptake of 68Ga-DOTATATE in the corresponding lesion. The patient subsequently underwent surgery to remove the lesion, which was pathologically confirmed as a pancreatic nesidioblastosis. This case showed that nesidioblastosis should be considered a differential diagnosis for insulinoma and that dual nuclear tracer PET/CT imaging is helpful for differentiating between the two. If conventional imaging techniques such as ultrasound, CT and MRI cannot identify the cause of hypoglycemia in future cases, dual-nuclide tracer PET/CT imaging should be considered.
摘要：
Nesidioblashy是成人高胰岛素血症性低血糖的罕见原因，其临床特征与复发性低血糖发作的胰岛素瘤相似。本研究报告了一名48岁男子在遵义医科大学附属医院就诊的病例（遵义，中国）有5年反复出现头晕、心悸等低血糖症状的病史。腹部磁共振成像(MRI)显示胰头有一个~1.2x1.0cm的肿块,怀疑是胰岛素瘤.为了确认，患者接受了氟-18-氟脱氧葡萄糖（18F-FDG）和镓-68标记的1,4,7,10-四氮杂环十二烷-1,4,7,10-四乙酸-d-Phel-Tyr3-Thr8-OC（68Ga-DOTATATE）正电子发射断层扫描/计算机断层扫描（PET/CT），在相应的病变中显示18F-FDG的摄取适度增加，但未摄取68Ga-DOTATATE。病人随后接受手术切除病灶,病理证实为胰腺肾母细胞病。此病例表明，应将nesidioblashase视为胰岛素瘤的鉴别诊断，并且双核示踪剂PET/CT成像有助于区分两者。如果传统的成像技术，如超声，CT和MRI无法确定未来病例中低血糖的原因，应考虑双核素示踪PET/CT成像。
