A Case of Hyperinsulinemia of Undetermined Origin, Successfully Treated with Long-acting Octreotide

Abstract

Abstract. Major causes of fasting hypoglycemia in adults are insulinoma, factitious hypoglycemia and nesidioblastosis. The primary treatment for insulinoma is surgical removal of the tumor, but there are cases with hyperinsulinemia that cannot undergo surgery. Somatostatin analogue is one of the treatments used in such cases of insulinoma or persistent hyperinsulinemic hypoglycemia. We report here a patient who had undetermined hyperinsulinemia and was successfully treated with a long-acting somatostatin analogue, which had recently become available. The patient, a 72-year-old female, who had previously been diagnosed as insulinoma and undergone partial pancreatectomy, was admitted complaining of the recurrence of hypoglycemic attacks after an interval of ten years. On admission, hypoglycemia (42 mg/dl), hyperinsulinemia (IRI: 79.3 mU/m) and low HbA1c (3.6%) were present. In 75g-OGTT at 30 min after load, IRI reached 6623 mU/ml, while plasma glucose level was 88 mg/dl. The anti-insulin antibody was not present. Since attempts at tumor localization by imaging techniques failed and the patient refused further examinations or surgical treatment, we recommended her to take a medication with a somatostatin analogue. Insulin suppression test using 50 mg of octreotide improved plasma glucose and IRI levels, suggesting the usefulness of the treatment, and a monthly administration of 20 mg of long-acting octreotide has successfully controlled her symptoms of hypoglycemia for 10 months. Our case demonstrated the utility of the long-acting somatostatin analogue for long-term treatment of undetermined hyperinsulinemia. A preliminary loading test using short-acting octreotide may be useful to determine appropriate medication, especially in cases who cannot receive surgical treatment.

Medical Treatment of Benign Insulinoma Using Octreotide LAR: A Case Report

“…In insulinomas without a somatostatin receptor, octreotide aggravates hypoglycemia due to suppression of glucagon and growth hormone [2,10]. Therefore, prior to starting octreotide treatment, the efficacy of octreotide should be assessed either by subcutaneous administration of a single dose [11] or by scintigraphy Time of meal is the following; breakfast at 7:00, lunch at 12:00, dinner at 18:00. Fig.…”

“…In cases of inoperable insulinoma whose localization of tumor was not detectable, or in cases of malignant insulinoma with metastatic lesions, long-term medical management of hypoglycemia is needed. Although a long-acting octreotide formulation such as octreotide LAR is effective for long-term treatment, there are only 4 reports of hyperinsulinemia including insulinoma treated with long-acting octreotide formulation [11,[16][17][18] (Table 3). Three cases were malignant insulinoma with liver metastasis, and one case was undetermined hyperinsulinemia.…”

A Case of Secretin-responsive Insulinoma with Low Serum C-peptide Levels

“…Service et al reported that insulinoma patients had C-peptide values at the end of the 72 h fasts greater than or equal to 0.20 nmol/mL (0.60 ng/mL); however, our case does not fulfill that criterion even before conducting the prolonged fasting test [12]. According to the data from the literature, the molar ratio of serum C-peptide to insulin is, in general, decreased in patients with insulinoma than normal subjects, while in our case the ratios were much lower (Table 2) [18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…In conclusion, this case report emphasizes some unusual features of an insulinoma, including a positive [18] 14.7 8 Kajinuma et al [19] 12.1 20 Okada et al [20] 11.2 136 Our case (after surgery) 17.6 1 Insulinoma Smythe et al [21] 20.0 1 Katabami et al [22] 7.2 4 Gin et al [23] 6.3 8 Sakai et al [18] 6.1 1 Scarlett et al [24] 5.9 1 Saudek [25] 5.6 1 Gerbitz and Spelsberg [26] 5.0 5 Lebowitz and Blumenthal [27] 4.9 3 Kondo et al [28] 4.2 3 Service [29] 3.6 1 Ciavarella et al [30] 2.9 1 Turner and Heding [31] 2.0 2 Our case (before surgery) 2.0 1 insulin response to secretin and decreased C-peptide levels, of which clinicians should be aware. The diagnosis of insulinoma should not depend on some particular endocrinological tests and should be made comprehensively.…”

Endurtekin krampaköst hjá ungri konu – sjúkratilfelli

“…Við þessar naeringarleiðbeiningar má baeta lyfjameðferð, diazoxide, alpha-glucosidasahemil eða octreotide sem gefið er með hverri stórmáltíð dagsins. [16][17][18][19] Fyrir fólk með alvarlegri einkenni blóðsykursfalls, til daemis einkenni sykurskorts í heila, er lyfjameðferð sjaldnast naeg og að-gerð því heppilegri kostur. Þá er oftast framkvaemt hlutabrottnám á fjaerhluta brissins.…”