Effective Therapy of Insulinoma by Using Long-Acting Somatostatin Analogue. A Case Report and Literature Review

Abstract

We are reporting a case of 68-year-old woman with insulinoma, after a non-successful tumor surgery and a long-term diazoxide treatment. She had a lot of hypoglycemia cases, and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in the diameter, in the head of the pancreas. The patient did not agree for the repeated insulinoma surgery. Furthermore, we found a lesion in the left adrenal gland (14 mm in the diameter) and in the right lung (8 mm in the diameter). Pheochromocytoma was diagnosed on the basis of hypertension, elevated levels of normetanephrine in the 24-h urine collection, and an elevated level of norepinephrine in a plasma sample. After the left adrenal gland removal we observed lower blood pressure. Since we had revealed the presence of somatostatin receptors by the somatostatin receptors scintigraphy, we decided to control hypoglycemia by a monthly subcutaneous administration of the long-acting lanreotide. Because of higher glucose levels (300-400 mg/dl) we started an intense insulin therapy. Nowadays, the patient feels better, she has lost 20 kg of her body weight, and we have observed normal blood glucose levels during the long-term lanreotide treatment. We have noticed neither side effects nor hypoglycemic episodes and we have reduced the dose of insulin. The presented case can be an evidence of the effective treatment of the pancreatic neuroendocrine tumor of insulinoma type, with somatostatin analogue.

Zalecenia ogólne dotyczące postępowania w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

“…Moreover, special care should be taken with insulinoma patients, as SSA may increase hypoglycaemia (reduced glucagon secretion, reduced secretion of the growth hormone). However, in malignant forms of insulinoma, during SSA therapy clinical symptoms may be reduced, and the disease stabilised [117]. In the case of malignant forms of gastrinoma, using SSA as second-line therapy can also be effective in alleviating disease symptoms [99].…”

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

“…Approximately 30-50% of patients respond to SSAs, although this treatment may be ineffective in the control of hypoglycaemia, and the condition of some patients may deteriorate during the therapy [200][201][202][203][204][205][206]. In certain cases hypoglycaemia may increase due to inhibited glucagon secretion [9,207].…”

“…In patients with malignant insulinomas, the medications used to control insulin secretion and hypoglycaemia include everolimus, mTOR inhibitor [9], effective in controlling hypoglycaemia in patients with malignant insulin-secreting tumours [200,201,203,205,208]. Sunitinib was also demonstrated to be effective in some patients.…”

Nowotwory neuroendokrynne trzustki — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

“…They are often ineffective in controlling hypoglycaemia (50-60% of insulinomas) and their effect on the blood glucose concentration varies [122]. In some cases, they may even intensify hypoglycaemia by inhibiting glucagon secretion [4,123].…”