• Xiaona Zhang, Hongwei Jia, Fengao Li, Chunyun Fang, Jinyang Zhen, Qing He, and Ming Liu.
• Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital.
• Medicine (Baltimore). 2021 Apr 2; 100 (13): e25076.

RationaleEctopic insulinomas are extremely rare and challenging to diagnose for clinicians. Precise preoperative localization is essential to successful treatment.Patient ConcernsA 23-year-old man presented with a 1-year history of recurrent hypoglycemia.DiagnosisExaminations in the local hospital did not reveal any pancreatic lesion. After admission, a fasting test and a 5-hour oral glucose tolerance test (OGTT) suggested a diagnosis of endogenous hyperinsulinemic hypoglycemia. Enhanced volume perfusion computed tomography (VPCT) revealed 2 nodules in the tail of the pancreas, a nodule in the gastric antrum, and a nodule in the hilum of the spleen. To differentiate which nodule was responsible for hypoglycemia, we performed 68Ga-Exendin-4 PET/CT and 68Ga-DOTATATE PET/CT which helped to make a conclusive diagnosis that the lesion in the gastric antrum was an ectopic insulinoma.InterventionsThe patient was cured with minimally invasive laparoscopic resection of the tumor.OutcomesThe symptoms were relieved and the blood glucose level remained normal after surgery.ConclusionsThis case shows that 68Gallium-exendin-4 PET/CT is useful for precise localization and thereby successful treatment of insulinoma, especially for occult insulinomas and those derived from an ectopic pancreas.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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