[68Ga]Ga-DOTA-TATE in diagnosis of MEN syndrome

12.09.2024

Multiple endocrine neoplasia (MEN) syndromes are inherited, autosomal dominant genetic disorders that affect the endocrine system. There are several types of MEN syndromes, and each type may cause different conditions or cancers. The diagnosis of MEN is multi stage and includes biochemical, hormonal, and several imaging tests. CLINICAL VIGNETTE A 40-year-old man with a history of muscle weak ness for 18 months and nephrolithiasis had multiple infiltrative lesions in the bone and a lesion in the pan creas suspected to be a neuroendocrine tumour (NET) on computed tomography (CT) scan. Hypercalcaemic breakthrough in the course of hyperparathyroidism was also diagnosed, and MEN syndrome was suspected.

As a first step, scintigraphy with 99m techne tium-sestamibi single-photon emission computed tomography/computed tomography ([99mTc]Tc-MIBI SPECT/CT) (Fig. 1A) was performed, which revealed typical prolongated focal radiotracer retention in 4 soft-tissue lesions, 3 in typical location and the other in mediastinum near the aortic arch, identified as hy peractive parathyroid glands (Fig. 1B, C). Additionally, areas of diffused, slightly increased tracer uptake were also observed in multiple osteolytic bone lesions with soft tissue components, identified as brown tumours, typical for hyperparathyroidism (Fig. 1D). Due to the suspicion of NET, gallium 68-tetraazacy clododecane-tetraacetic acid-octreotate positron emission tomography computed tomography ([68Ga]Ga-DO TA-TATE PET/CT) (Fig. 1E) was performed, which showed increased somatostatin receptor expression in the body of the pancreas [maximum standardised up take value (SUVmax) 16.9] and the duodenum (SUVmax 11.7) (Fig. 1H). Increased radiotracer accumulation was also present in parathyroids (SUVmax up to 6.1) (Fig. 1F) and brown tumours (SUVmax up to 9.7) (Fig. 1G) previously visible in [99mTc]Tc-MIBI scintigraphy. Abnor mally low tracer accumulation in the pituitary was also noted (SUVmax 4.0), and the possibility of hormonal suppression was suggested, which was confirmed after additional endocrine blood tests.

Full publication in Endokrynologia Polska »