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The area under the ROC of 68 Ga-exendin-4 PET/CT for diagnosing insulinoma was 0.975 (95%CI, 0.953 0.988), which was superior to that of CECT (AUC = 0.873 [95%CI, 0.833 0.906]), MRI (AUC = 0.825 [95%CI, 0.773 0.869]), EUS (AUC = 0.746 [95%CI, 0.652 0.825]) and 99m Tc-HYNIC-TOC SPECT/CT (AUC = 0.618 [95%CI, 0.562 0.672])

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This suppresses production of pro-inflammatory cytokines including TNF-alpha, IL-1beta, and IL-6 (the same IL-6 that paradoxically stimulates GLP-1 production in a feedback loop)

This adverse metabolic profile may further exacerbate cardiovascular risk by increasing oxidative stress and endothelial dysfunction, as androgen-mediated activation of metabolic pathways alters myocardial energy balance and redox homeostasis (73)