• Yunuan Liu, Xinming Zhao, Jingmian Zhang, Jianfang Wang, Zhaoqi Zhang, Meng Dai, Na Wang, Fenglian Jing, Tingting Wang, and Weiwei Tian.
• Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
• Medicine (Baltimore). 2022 Aug 26; 101 (34): e30252.

RationaleMultiple endocrine neoplasia type 1 (MEN1) syndrome is a rare and complicated disease that is associated with several endocrine tumors. Here, we report a case of MEN1 associated with insulinoma, parathyroid, and pituitary tumors by 68Ga-DOTATATE positron emission tomography/computed tomography (PET/CT).Patient ConcernsA 49-year-old woman presented with intermittent hypoglycemia for more than a year and developed indistinct consciousness without an apparent trigger.DiagnosesBiochemical results showed abnormally high serum insulin and parathyroid hormone levels. She underwent an Abdominal magnetic resonance imaging revealed a small nodule in the uncinate process of the pancreas, but it did not clarify the nature of the small nodule. Pituitary magnetic resonance imaging scan revealed a micropituitary tumor, and parathyroid imaging showed no abnormalities. 18F-FDG PET/CT showed no apparent abnormal 18F-FDG uptake in the whole body. In contrast, 68Ga-DOTATATE PET/CT imaging showed pathological radiotracer uptake in the pancreatic uncinate process, accompanied by mild radiotracer uptake in the pituitary gland, and no apparent abnormal radiotracer uptake in the parathyroid area.InterventionsThe patient underwent echoendoscopy for pancreatic uncinate process lesions and surgical resection.OutcomesHistological analysis was suggested of insulinoma of pancreatic neuroendocrine tumor, the Ki-67 index was low (only 1% being positive).LessonsThis case demonstrates that 68Ga-DOTATATE can be used for the detection of MEN1-related tumors and preoperative localization of small and low-grade insulinomas by PET/CT.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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