![]() They are capable of secreting insulin in an autonomous fashion resulting in life-threatening hypoglycemia. Insulinomas are rare (incidence 1-4/Mio/year), usually benign insulin-secreting neuroendocrine neoplasms (NEN) located in the pancreas ( Service et al. This review focuses on the potential use of GLP-1R imaging in the differential diagnosis of EHH. In special cases of endogenous hyperinsulinemic hypoglycemia (EHH), that is, in the context of MEN-1 or adult nesidioblastosis GLP-1R imaging is useful whereas in postprandial hypoglycemia in the context of bariatric surgery, GLP-1R imaging is probably not helpful. Importantly, one of the two receptors appears to be always overexpressed. In contrast to benign insulinomas, malignant insulin-secreting neuroendocrine tumors express GLP-1R in only one-third of the cases, while they more often express the somatostatin subtype 2 receptors. It is likely that this new non-invasive technique has the potential to replace the invasive localization of insulinomas by selective arterial stimulation and venous sampling. Targeting GLP-1R with indium-111, technetium-99m or gallium-68-labeled exendin-4 offers a new approach that permits the successful localization of small benign insulinomas. In particular, virtually all benign insulinomas express GLP-1R in high density. Receptors for the incretin glucagon-like peptide-1 (GLP-1R) have been found overexpressed in selected types of human tumors and may, therefore, play an increasingly important role in endocrine gastrointestinal tumor management.
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