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68Ga-DOTANOC PET/CT mimicking renal dynamic scan: Lack of physiological uptake in the spleen of a newborn and the pituitary gland in congenital hyperinsulinism
68Ga-DOTANOC PET/TC scan imitando dinámica renal: Falta de captación fisiológica en el bazo y la hipófisis de un recién nacido en el hiperinsulinismo congénito
G. Kumar, V.S. Dhull, S. Karunanithi, C. Bal, R. Kumar
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Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kumar, V.S. Dhull, S. Karunanithi, C. Bal, R. Kumar" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Kumar" ] 1 => array:2 [ "nombre" => "V.S." "apellidos" => "Dhull" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Karunanithi" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Bal" ] 4 => array:4 [ "nombre" => "R." "apellidos" => "Kumar" "email" => array:1 [ 0 => "rkphulia@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleSup">68</span>Ga-DOTANOC PET/TC scan imitando dinámica renal: Falta de captación fisiológica en el bazo y la hipófisis de un recién nacido en el hiperinsulinismo congénito" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1840 "Ancho" => 3285 "Tamanyo" => 314812 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">68</span>Ga-DOTANOC maximum intensity projection PET images revealed the physiological excretion of the radiotracer through kidneys, ureters and bladder; thus mimicking a renal dynamic scan (A). Transaxial CT and PET/CT images of pituitary gland (B, C) and spleen (D, E), which revealed no significant physiological <span class="elsevierStyleSup">68</span>Ga-DOTANOC uptake. Also, no abnormal uptake was noted in the pancreas (A).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of 25-day-old neonate who presented with recurrent and persistent hypoglycemia refractory to medical treatment. At 22<span class="elsevierStyleHsp" style=""></span>h of life, the baby developed hypoglycemia (22<span class="elsevierStyleHsp" style=""></span>mg/dl), put on glucose infusion rate (GIR) of 6<span class="elsevierStyleHsp" style=""></span>mg/kg/min gradually increased to 12<span class="elsevierStyleHsp" style=""></span>mg/kg/min. In view of persistent hypoglycemia, hydrocortisone 5<span class="elsevierStyleHsp" style=""></span>mg/kg/day was started on day 3. The baby gradually required GIR of 24<span class="elsevierStyleHsp" style=""></span>mg/kg/min and multiple drugs (octreotide 25 mcg/kg/min, chlorthiazide 7.5<span class="elsevierStyleHsp" style=""></span>mg/kg/day, diazoxide 20<span class="elsevierStyleHsp" style=""></span>mg/kg/day and hydrocortisone 10<span class="elsevierStyleHsp" style=""></span>mg/kg/day). Critical sample of the baby showed hyperinsulinism (10.11<span class="elsevierStyleHsp" style=""></span>μU/ml), cortisol and C peptide were normal. The baby was maintaining sugar on multiple drugs on day 15 and all drugs were gradually reduced over a period of 10 days and is now on diazoxide 5<span class="elsevierStyleHsp" style=""></span>mg/kg/day only. In view of persistent hypoglycemia refractory to medical treatment, the baby was referred for <span class="elsevierStyleSup">68</span>Ga-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-octreotide (DOTANOC) positron emission tomography/computed tomography (PET/CT) to localize the lesion. <span class="elsevierStyleSup">68</span>Ga-DOTANOC PET/CT showed the physiological excretion of the radiotracer through kidneys, ureters and bladder; thus mimicking a renal dynamic scan (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). No significant physiological <span class="elsevierStyleSup">68</span>Ga-DOTANOC uptake was noted in spleen or pituitary (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–E). Also, no abnormal uptake was noted in the pancreas.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In congenital hyperinsulinism of infancy (CHI), the pre-operative differentiation of focal from diffuse form is important from management point of view. Although, <span class="elsevierStyleSup">18</span>F-fluoro-DOPA PET imaging is the norm, somatostatin receptor (SSTR) imaging has also been used. Five subtypes of SSTR (SSTR 1–5) have been discovered. <span class="elsevierStyleSup">68</span>Ga-DOTANOC is an octreotide-based radiopharmaceutical which carries a high affinity particularly for SSTR 2 and 5.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The physiologic uptake of <span class="elsevierStyleSup">68</span>Ga-DOTANOC in spleen is due to higher expression of SSTR 2 (particularly SSTR 2a) mRNA in spleen which gradually increases with age.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Fetal pituitary expresses SSTR 2 as early as 16 weeks of fetal life but the developmental pattern of expression varies considerably.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The uptake in the pancreas appeared very diffuse and mild to be considered significant (SUVmax pancreas<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.85; SUVmax liver<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.96). Although immunohistochemical analysis of human pancreatic tissue sections has revealed that SSTR2 is the main type present in both β-cells and α-cells, but the exact age of maturation is not known.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Therefore, present case highlights the fact that the physiological distribution of <span class="elsevierStyleSup">68</span>Ga-DOTANOC can differ in early life due to incomplete/immature expression of the SSTR and has to be kept in mind while reporting such cases. Future studies are warranted to substantiate the incomplete/immature expression of the SSTR in early life.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0015" class="elsevierStylePara elsevierViewall">No funding received from any organization for this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-30" "fechaAceptado" => "2013-12-05" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1840 "Ancho" => 3285 "Tamanyo" => 314812 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">68</span>Ga-DOTANOC maximum intensity projection PET images revealed the physiological excretion of the radiotracer through kidneys, ureters and bladder; thus mimicking a renal dynamic scan (A). Transaxial CT and PET/CT images of pituitary gland (B, C) and spleen (D, E), which revealed no significant physiological <span class="elsevierStyleSup">68</span>Ga-DOTANOC uptake. Also, no abnormal uptake was noted in the pancreas (A).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel use of somatostatin receptor scintigraphy in localization of focal congenital hyperinsulinism: promising but fallible" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Dutta" 1 => "S. Venkataseshan" 2 => "C. Bal" 3 => "K.L. Rao" 4 => "K. Gupta" 5 => "A. 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Gloyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajpendo.00207.2012" "Revista" => array:6 [ "tituloSerie" => "Am J Physiol Endocrinol Metab" "fecha" => "2012" "volumen" => "303" "paginaInicial" => "E1107" "paginaFinal" => "E1116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22932785" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2253654X/0000003300000006/v1_201410310138/S2253654X14000079/v1_201410310138/en/main.assets" "Apartado" => array:4 [ "identificador" => "7907" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes de interés" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/2253654X/0000003300000006/v1_201410310138/S2253654X14000079/v1_201410310138/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X14000079?idApp=UINPBA00004N" ]
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