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Location of a VIPoma by Iodine-123-Vasoactive Intestinal Peptide Scintigraphy

Departments of Nuclear Medicine, Internal Medicine, Clinical Pathology, Gastroenterology, General Surgery and Radiology, University of Vienna, Vienna
Department of Radiochemistry, Research Center, Seibersdorf, Austria
Department of Internal Medicine, Charles University of Prag, Czech Republic

Correspondence: For correspondence or reprints contact: Irene Virgolini, MD, Department of Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.

ABSTRACT

A major problem in patients with small endocrine tumors is the difficulty in localizing the primary tumor site. Many endocrine tumors possess larger amounts of high affinity vasoactive intestinal peptide (VIP) binding sites compared with normal tissue or blood cells. We used radiolabeled VIP to localize the tumor site in a patient with Verner-Morrison syndrome (VMS). Under octreotide therapy, the VIP levels had declined in this patient, but a tumor site could not be detected by conventional techniques or by radiolabeled octreotide. However, using ¹²³I-VIP, the tumor was detectable in the pancreatic tail. Surgical resection of the tumor was followed by complete remission of the VMS. Expression of VIP binding sites in the tumor was confirmed by a radioreceptor assay and showed cross-competition between VIP and octreotide. The identity of the VIP binding site in the tumor was analyzed by Northern blotting and revealed the expression of somatostatin receptor subtype 3, which binds both somatostatin-14 and VIP with higher affinity than octreotide. Iodine 123-VIP scintigraphy would be an effective tracer to identity the tumor site in VMS patients.

Key Words: vasoactive intestinal peptide • Verner-Morrison syndrome • somatostatin • VIPoma • scintigraphy

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