18 F-DOPA PET/MRI With Carbidopa for the Diagnosis of Hyperinsulinemic Hypoglycemia in an Adolescent Patient.
Carine AnkaMaria Rosana PonisioPatrick A DillonChelsea SchmittTyler J FraumAna Maria ArbelaezPublished in: JCEM case reports (2024)
Hyperinsulinism due to focal or diffuse pancreatic lesions causing recurrent episodes of hypoglycemia is rare in mid-childhood. There is no consensus on the gold-standard imaging method to diagnose focal insulin-producing lesions beyond infancy. A 14-year-old boy with a complex medical history and refractory epilepsy, presented with blood glucose (BG) of 52 mg/dL (2.9 mmol/L) (normal reference range: 70-100 mg/dL [3.9-5.6 mmol/L]) and increased seizure frequency. He failed a fast within 4 hours, with BG of 48 mg/dL (2.7 mmol/L) and insulin level of 4.6 µIU/mL (24.6 pmol/L) (diagnostic at the time of hypoglycemia >1.25 μU/mL [8.7 pmol/L]). Conventional imaging studies showed no pancreatic lesion. Fluorine-18-L-dihydroxyphenylalanine positron emission tomography/magnetic resonance imaging ( 18 F-DOPA-PET/MRI) scan premedicated with carbidopa demonstrated intense focal 18 F-DOPA uptake in the distal pancreatic tail. He underwent distal pancreatectomy. Histopathology showed focal pancreatic islet cell hyperplasia, with more than 90% of the neuroendocrine islet cells being positive for chromogranin and synaptophysin, with no loss of p57 staining. Genetic studies were negative for mutations in ABCC8 , KCNJ11 , GCK , or GLUD1 genes, multiple endocrine neoplasia (MEN) type 1, and Beckwith-Wiedemann syndrome. BG normalized after surgery. Seizure frequency improved. This case highlights the utility of 18 F-DOPA PET/MRI imaging in diagnosing focal hyperinsulinism beyond infancy.
Keyphrases
- positron emission tomography
- computed tomography
- magnetic resonance imaging
- type diabetes
- glycemic control
- contrast enhanced
- blood glucose
- high resolution
- pet imaging
- pet ct
- diffusion weighted imaging
- healthcare
- case report
- minimally invasive
- weight gain
- magnetic resonance
- young adults
- mental health
- cell cycle arrest
- single cell
- oxidative stress
- metabolic syndrome
- physical activity
- low grade
- adipose tissue
- photodynamic therapy
- body mass index
- cell therapy
- cell death
- case control
- weight loss
- stem cells
- blood pressure