68Ga-Exendin-4 PET/CT Enables Identification of Multiple and Ectopic Insulinoma in a Patient With Multiple Endocrine Neoplasia 1

A 53-year-old woman with hyperinsulinemic hypoglycemia was diagnosed with multiple insulinomas as determined by contrast-enhanced CT. Genetic test confirmed the presence of multiple endocrine neoplasia type 1 (MEN1). 68 Ga-exendin-4 PET/CT revealed multiple lesions with intense uptake in the tail and uncinate process of the pancreas, with an additional lesion in the gastric wall on the lesser curvature. These lesions were subsequently confirmed to be insulinomas by histopathologic examination after surgery. This case illustrates the benefits of 68 Ga-exendin-4 PET/CT in detecting multiple and ectopic insulinomas in patients with a MEN1 background.