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Congenital Hyperinsulinism: Pancreatic [¹⁸F]Fluoro-L-Dihydroxyphenylalanine (DOPA) Positron Emission Tomography and Immunohistochemistry Study of DOPA Decarboxylase and Insulin Secretion

Departments of Pediatrics (P.d.L., I.G., M.P., J.-J.R.), Biology (A.S.-C., K.L.), Radiology (N.B., F.B.), Pathology (V.V., F.J.), and Pediatric Surgery (C.N.-F.), Hôpital Necker Enfants Malades, Université Paris-Descartes, Faculté de Médecine, 75743 Paris, France; ERM 0205 Institut National de la Santé et de la Recherche Médicale-Commissariat à l’Energie Atonomique (M.-J.R., A.S.), Service Hospitalier Frédéric Joliot, DSV, DRM, 91401 Orsay, France; Department of Biology (C.B.-C.), Hôpital Saint-Antoine, 75571 Paris, France; Department of Pathology (J.R.), University of Louvain, Faculty of Medicine, B-1200 Brussels, Belgium; and Radiological Associates of Sacramento (D.S.), Sutter Medical Center, Sacramento, California 95816

Address all correspondence and requests for reprints to: Dr. Pascale de Lonlay, Département de Pédiatrie, Hôpital Necker–Enfants Malades, Université Paris-Descartes, Faculté de Médecine, 149 rue de Sèvres, 75743 Paris cedex 15, France. E-mail: pascale.delonlay{at}nck.aphp.fr.

Context: Congenital hyperinsulinism (HI) is characterized by hypoglycemia related to inappropriate insulin secretion. Focal and diffuse forms of hyperinsulinism share a similar clinical presentation, but their treatment is dramatically different. Preoperative differential diagnosis was based on pancreatic venous sampling, a technically demanding technique.

Objective: Positron emission tomography (PET) after injection of [¹⁸F]fluoro-L-DOPA (L-dihydroxyphenylalanine) has been evaluated for the preoperative differentiation between focal and diffuse HI, by imaging uptake of radiotracer and the conversion of [¹⁸F]fluoro-L-DOPA into dopamine by DOPA decarboxylase. We propose to validate this test by immunohistochemical approach.

Patients and Methods: Pancreatic surgical specimens of four focal and three diffuse HI were studied, using anti-DOPA decarboxylase and proinsulin antibodies. The effect of an inhibitor of DOPA decarboxylase (carbidopa) on insulin secretion was evaluated in vivo and in cultured INS-1 cells.

Results: Immunohistochemical detection of DOPA decarboxylase showed diffuse staining of Langerhans islets in the whole pancreas in all diffuse cases, in contrast with dense focal staining in all focal cases. Staining of Langerhans islets outside the focal lesion was diffusely but weakly positive. We correlated the localization of DOPA decarboxylase and proinsulin in normal pancreas and in both diffuse and focal HI tissues. The diffuse PET uptake found before treatment in one child with diffuse HI disappeared completely after carbidopa administration, suggesting in vivo that pancreatic cells can take up amine precursors and contain DOPA decarboxylase. The insulin secretion measured in the supernatant was the same whether INS-1 cells were treated by dopamine or Lodosyn or untreated.

Conclusion: We validate PET with as a consistent test to differentiate diffuse and focal HI.

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