Bifocal Insulinoma Detected With 68Ga-Exendin PET/CT and Treated With Endoscopic Ultrasound-guided Radiofrequency Ablation: Toward a Gold-Standard Management?

We report the case of a 48-year-old woman who presented with hyperinsulinemic hypoglycemia, suggestive of an underlying insulinoma. Conventional morphologic and functional work-ups failed to identify the tumor. A 68 Ga-Exendin PET/CT ultimately detected 2 subcentimetric pancreatic insulinomas. A conservative endoscopic ultrasound-guided radiofrequency ablation was performed. Before the procedure, a dual-energy spectral CT, guided by the PET findings, confirmed the lesions. This treatment successfully normalized blood glucose levels. This case underscores the importance of new diagnostic and therapeutic tools for the optimized management of patients with insulinomas.