MDCT of the Endocrine Pancreas
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Gastrinoma
Endocrine gland
Exocrine pancreas
Glucagon-like peptide 1 (GLP-1) receptors expression has been found on many types of cancer cells. In case of benign insulinoma the density of those receptors is even higher than the density of somatostatin receptors. This article presents the results of clinical trials proving the utility of GLP-1 receptors imaging. Scintigraphy or positron emission tomography with the use of GLP-1 analogues labelled with appropriate radioisotopes (111In, 99mTc, 68Ga, 18F or 64Cu) seem to be superior compared with other available techniques in diagnosis of hardly detectable benign insulinoma. While surgery is the only effective therapy for insulinoma patients, therefore proper preoperative localization of the tumor allows sparing operation. Glucagon-like peptide 1 receptors might become also a target for imaging of other tumors such as gastrinoma, pheochromocytoma and medullary thyroid cancer (MTC), which also were shown to overexpress this type of receptors. However, studies with larger groups of patients are required to prove the clinical usefulness of this indication. Moreover GLP-1 receptor imaging seems to be a potential tool to evaluate pancreatic beta cell mass (BCM). It may be useful in the early diagnosis of beta cell loss in preclinical phases of diabetes. The panceratic beta cells imaging may influence the prophylaxis of diabetes and management of diabetic patients. Presented results of clinical trials prove that glucagon-like peptide 1 receptor imaging might become helpful diagnostic strategy particularly in case of patients with benign insulinoma tumors, but also patients with gastrinoma, pheochromocytoma, medullary thyroid cancer and diabetes.
Gastrinoma
Medullary Thyroid Cancer
New horizons
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Gastrinoma
Zollinger-Ellison syndrome
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The surgical management of pancreatic endocrine tumors in patients with multiple endocrine neoplasia type 1 remains controversial. Gastrinoma and insulinoma are the 2 most common functional pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. Gastrinomas cause gastric acid hypersecretion and peptic ulcer disease that are best managed using proton pump inhibitors. Surgery to remove the gastrinoma in patients with multiple endocrine neoplasia type 1 is seldom curative unless a more extensive Whipple pancreaticoduodenectomy is performed. Because the prognosis is excellent, aggressive resections such as a Whipple procedure are only indicated for large, locally metastatic, advanced tumors. Furthermore, surgery to remove imageable tumors that are 2 cm in diameter is associated with excellent outcomes and decreased probability of liver metastases. Because gastrinomas are commonly multiple and most originate in the duodenum and develop lymph node metastases, the duodenum should be opened and all tumors and lymph nodes excised. Insulinomas cause hypoglycemia that results in neuroglycopenic symptoms. Medical management of the hypoglycemia is less effective than that of the gastric acid hypersecretion. Fortunately, the insulinoma is usually clearly identified using routine pancreatic imaging studies. There is a high likelihood of cure when the insulinoma is excised surgically. However, recurrent hypoglycemia may occur, and careful follow-up is indicated.
Gastrinoma
Whipple Procedure
Zollinger-Ellison syndrome
Glucagonoma
MEN1
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Purpose of this study is to analyze the modern methods of diagnostics and comparison the methodsof pancreatic neuroendocrine tumors (NET PG) removal using laparotomic and laparoscopic technique. Materials and Methods. We have analysed efficiency of four methods of localization of neuro-endocrine tumors of pancreas: ultrasound, endoscopic transgastric ultrasound, computed tomography, angiography. Results. Neuro-endocrine tumors of pancreatic gland were diagnosed in 46 patients: benign insulinoma – 33 (71,7%), malignant insulinoma – 5 (10,9%), malignant carcinoid of pancreatic gland – 3 (6,5%), somatostatinoma – in 3 (6,5%) patients, gastrinoma – in 2 (4,4%) cases. Age of the patients was from 17 tol 83 years. The most sensitive was computed tomography – 93,7%. Conclusion. We have compared results of treatment of patients, who were performed conventional laparotomic and laparoscopic operation. Laparoscopy was efficient operation with favourable postoperative period.
Gastrinoma
Endoscopic Ultrasound
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Purpose of this study is to analyze the modern methods of diagnostics and comparison the methods of pancreatic neuroendocrine tumors (NET PG) removal using laparotomic and laparoscopic technique.Materials and Methods. We have analysed efficiency of four methods of localization of neuro-endocrine tumors of pancreas: ultrasound, endoscopic transgastric ultrasound, computed tomography, angiography.Results. Neuro-endocrine tumors of pancreatic gland were diagnosed in 46 patients: benign insulinoma – 33 (71,7%), malignant insulinoma – 5 (10,9%), malignant carcinoid of pancreatic gland – 3 (6,5%), somatostatinoma – in 3 (6,5%) patients, gastrinoma – in 2 (4,4%) cases. Age of the patients was from 17 to 83 years. The most sensitive was computed tomography – 93,7%.Conclusion. We have compared results of treatment of patients, who were performed conventional laparotomic and laparoscopic operation. Laparoscopy was efficient operation with favourable postoperative period.
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Somatostatin receptor scintigraphy is the best imaging method to identify the presence of neuroendocrine gastroenteropancreatic tumours. Nevertheless, a well structured surgical approach incorporating specific intra-operative methods can localize those tumours that cannot be readily detected by this imaging technique. In the case of gastrinoma, standard palpation allows duodenal tumour detection in approximately 60% of cases, endoscopic transillumination, in more than 80%. Furthermore, adding duodenotomy, 95-97% duodenal tumours can be localized. Intraoperative ultrasound, instead, does not add much to standard palpation in duodenal gastrinoma localization. For insulinoma detection, among the intra-operative methods, inspection gives the poorest results, identifying the lesion in only 20% of cases. Palpation offers better results, localizing 60-80% of insulinomas. The introduction of intra-operative ultrasound has revolutionized the ability to find pancreatic insulinoma, allowing the surgeon to identify the insulinoma in nearly every patient.
Palpation
Gastrinoma
Endoscopic Ultrasound
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Gastrinoma
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The insulinoma syndrome is marked by fasting hypoglycemia and inappropriate elevations of insulin. The gastrinoma syndrome is characterized by hypergastrinemia, ulcer disease, and/or diarrhea. Rarely, insulinoma and gastrinoma coexist in the same patient simultaneously.Our objective was to determine the cause of a patient's hypoglycemic episodes and peptic ulcer disease.This is a clinical case report from the Clinical Research Center of the National Institutes of Health.One patient with hypoglycemic episodes and peptic ulcer disease had a surgical resection of neuroendocrine tumor.The patient was found to have a single tumor cosecreting both insulin and gastrin. Resection of this single tumor was curative.A single pancreatic neuroendocrine tumor may lead to the expression of both the hyperinsulinemic and hypergastrinemic syndromes.
Gastrinoma
Zollinger-Ellison syndrome
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Gastrinoma
Carcinoid tumors
Zollinger-Ellison syndrome
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