A 72-year-old woman with a history of diabetes mellitus presented with severe episodes of hypoglycemia, associated with diaphoresis and somnolence, for 1 year. Workup revealed high insulin and c-peptide. Given the clinical suspicion of an insulinoma, an MRI was performed, which demonstrated abnormal enhancement in the pancreatic head. An octreotide scan with combined single-photon emission computed tomography–computed tomography was performed and fused to the MR, which identified radiotracer uptake at the site of the MR enhancement, enabling precise localization of a pancreatic somatostatin receptor–avid tumor. The patient underwent tumor enucleation with pancreatojejunostomy, and pathologic tests confirmed an insulinoma.
From the *Department of Radiology and Imaging Sciences, †Division of Nuclear Medicine, and Departments of ‡Surgery, §Pathology and Laboratory Medicine, and Radiation Oncology, Emory University School of Medicine, Atlanta, GA.
Received for publication April 7, 2011; revision accepted August 2, 2011.
Conflicts of interest and sources of funding: none declared.
Reprints: Valeria M. Moncayo, MD, 1364 Clifton Road NE, Room D125A, Atlanta, GA 30322. E-mail: email@example.com.