Outcomes of 68Ga-NODAGA-Exendin-4 PET/CT Guided Surgical Management of Insulinomas in MEN1: A Preliminary Study

Ketki Sunil Ambulkar; Ravikumar Shah; Anurag Lila; Anima Sharma; Rohit Barnabas; Manjiri Karlekar; Saba Samad Memon; Vijaya Sarathi; Sameer Rege; Priyanka Verma; Gaurav Malhotra; Vikram Lele; Tushar Bandgar

doi:10.1055/a-2694-8248

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2025; 64(05): 301-307
DOI: 10.1055/a-2694-8248

Original Article

Outcomes of 68Ga-NODAGA-Exendin-4 PET/CT Guided Surgical Management of Insulinomas in MEN1: A Preliminary Study

Authors

Ketki Sunil Ambulkar‡

¹Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Maharashtra, India
Ravikumar Shah‡

²Harikrushna Hormone Clinic, Anand, India
Anurag Lila

³Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Maharashtra, India
Anima Sharma

⁴Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Maharashtra, India
Rohit Barnabas

⁵Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Maharashtra, India
Manjiri Karlekar

⁶Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Maharashtra, India
Saba Samad Memon

⁷Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Maharashtra, India
Vijaya Sarathi

⁸Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
Sameer Rege

⁹Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
Priyanka Verma

¹⁰Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, India
Gaurav Malhotra

¹¹Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, India
Vikram Lele

¹²Department of Nuclear Medicine, Jaslok Hospital & Research Center, Nagpur, India
Tushar Bandgar

¹³Department of Endocrinology and Metabolism, Seth GS Medical College and KEM Hospital, Maharashtra, India

Abstract

The data on the use of ⁶⁸Ga-NODAGA-exendin-4 PET/CT in localizing multiple endocrine neoplasia type 1 (MEN1)-related insulinomas is evolving; however, surgical outcomes data are not available. We describe our cohort of patients with MEN1-related endogenous hyperinsulinemic hypoglycemia (EHH), where ⁶⁸Ga-NODAGA-exendin-4 PET/CT was used to guide conservative surgery. A retrospective record review of MEN1-related EHH cases managed between 2000 and 2024 was performed for clinical features, imaging, and management. Outcomes were assessed for patients whose surgical extent was determined by ⁶⁸Ga-NODAGA-exendin-4 PET/CT versus conventional imaging (CECT and ⁶⁸Ga-DOTATATE PET/CT). Five patients with a median age of 17 (15.5–18.5 years) with EHH underwent laparoscopic, single lesion enucleation based on ⁶⁸Ga-NODAGA-exendin-4 PET/CT. On preoperative imaging, CT identified culprit lesion in four, while ⁶⁸Ga-DOTATATE PET/CT localized in one, and had one false positive uptake in non-functioning NET. The median duration of hospital stay was 6 (5.5–9) days. Over a median follow-up of 48 (3.5–84.5) months, none had EHH recurrence or exocrine/endocrine pancreatic insufficiency. On follow-up, one patient had an uneventful pregnancy and delivery. In the remaining 15, who underwent surgery based on conventional imaging, 12 (80 %) required extensive surgery beyond enucleation, of which two needed intraoperative ultrasound localization. This group had a postoperative hospital stay of 11 (8–23) days, one recurrence after 84 months, and pancreatic insufficiency in 5 (33 %). Our center observation suggests that GLP1R-based PET/CT-guided conservative insulinoma surgery in MEN1 patients is effective and safe and needs further validation.

Keywords

MEN1 - exendin - GLP1 - surgical outcomes - insulinoma - endogenous hyperinsulinemic hypoglycemia

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Referenzen

References
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