MEDIA RELEASE
Singapore, 28 March 2025 — Spotting insulinomas, rare pancreatic tumours that overproduce insulin, can be tricky. These tumours are hard to find as they can be as small as a few millimetres across and hidden in difficult-to-reach areas of the pancreas, which makes treatment challenging and sometimes incomplete.
The Singapore General Hospital (SGH) has introduced a new imaging technique that effectively uncovers such tumours, allowing patients to opt for less invasive surgical approach. An elderly patient from the Tan Tock Seng Hospital (TTSH) was the first to have benefited from the new scan last year through a collaborative effort across healthcare clusters and disciplines.
Exendin-4 Imaging: A Game Changer
Diagnosing insulinomas typically requires a combination of prolonged fasting tests, blood analyses, and imaging studies such as Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scans, and tissue biopsy. Although these conventional methods complement one another in most of the cases, there are rare situations where the final diagnosis cannot be confirmed, or where small tumours fail to be pinpointed. This is where the novel exendin-4 imaging technique comes in handy, as a specific adjunct test to confirm the diagnosis of insulinoma and enable more precise localisation.
Exendin-4, tagged with a radioactive material through a specialised radiolabelling process, highlights insulinomas as distinct bright spots during Positron Emission Tomography (PET) / CT scans. This advancement improves diagnostic accuracy, guiding clinicians to plan effective treatment strategies.
Dr. Huang Hian Liang, Senior Consultant, Department of Nuclear Medicine and Molecular Imaging, SGH, highlights: “The introduction of exendin-4 imaging represents a significant milestone in the diagnostic approach to insulinomas, adding to the toolbox of investigations that clinicians can use to confirm and pinpoint the location of these small and easy-to-miss tumours. By improving tumour localisation, we can offer patients more targeted and potentially minimally invasive treatment options.”
Treatment Innovations
Traditionally, surgery has been the mainstay treatment for insulinomas. While highly effective, pancreatic surgery—especially for tumours in the pancreatic head—carries significant risks. For patients who are unable to undergo surgery, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offers a minimally invasive alternative.
Dr. Charles Vu, Senior Consultant, Department of Gastroenterology and Hepatology, TTSH, explains: “Performed under sedation using a special endoscope introduced via the mouth (and usually in less than one hour), EUS-RFA uses thermal energy to destroy insulin-producing tumour cells, resolving symptoms without precluding later surgical options if needed. EUS-RFA is a valuable option for elderly patients or those with significant surgical risks. The procedure can be repeated in recurrent cases.”
Multidisciplinary Collaboration
The diagnosis and management of insulinomas exemplify the multidisciplinary approach we adopt in managing insulinomas, leveraging the expertise of endocrinologists, radiologists, gastroenterologists, and surgeons. Teams from TTSH and SGH have worked together to refine diagnostic pathways and integrate innovative treatments, ensuring optimal outcomes for patients.
Patient Outcomes and Future Directions
Successful treatment often results in a complete cure with no recurrence, especially for solitary, slow-growing tumours. However, recurrence or inoperable cases—often due to genetic predispositions or advanced disease—require ongoing management. The combination of cutting-edge imaging and minimally invasive techniques offers hope for improved outcomes even in complex cases.
Understanding Insulinomas
Insulinomas are rare but impactful, causing excessive insulin production that leads to recurrent episodes of low blood sugar. Symptoms include tremors, confusion, fainting, and seizures, all of which resolve when blood sugar levels normalise. While most insulinomas are slow-growing and benign, they can evade detection for years due to their small size and gradual symptom onset. The condition is more common in females and most often appear in people between the ages of 40 and 60.
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For media enquiries, please contact:
Candice Lee
Communications Department
Singapore General Hospital
Jasmine Chia
Communications
Tan Tock Seng Hospital
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