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

Abstract

Abstract. In some patients with insulinoma, surgery is not possible due to either difficulties in detecting the tumor or advanced age. These patients need medical treatment for hypoglycemia. We report a case of benign insulinoma using the long-acting octreotide formulation, octreotide long-acting repeatable (octreotide LAR), as a medical therapy. A 67-yearold woman was referred to our hospital for examinations of hypoglycemia. A blood sample taken during a hypoglycemic episode revealed low plasma glucose concentration, hyperinsulinemia and a high C-peptide level. An abdominal CT scan demonstrated a hypervascular tumor in the body of pancreas. She was diagnosed with insulinoma. As the patient refused surgical resection of the pancreas tumor, we started to use the somatostatin analogue, octreotide, for treatment of hypoglycemia. After the treatment her plasma glucose levels were elevated and serum immunoreactive insulin (IRI) levels were decreased. For long-term treatment, we changed the treatment from daily subcutaneous injection of octreotide to monthly intramuscular administration of octreotide LAR. This treatment was also effective and hypoglycemic attacks disappeared. Both plasma glucose levels and serum IRI levels were improved. Our case demonstrated that octreotide LAR was useful for long-term medical treatment of insulinoma.

Post-prandial Hypoglycemia after Bariatric Surgery: Pharmacological Treatment with Verapamil and Acarbose

“…Pharmacological treatment with diazoxide, octreotide, and calcium channel blockers has been tried in patients with insulinoma who fail to respond to surgical treatment or those who have contraindications to surgery [9][10][11]. In patients with reactive hypoglycemia, alfa-glicosidase inhibitors, particularly acarbose, have also been used [12][13][14].…”

Usefulness of the octreotide test in Japanese patients for predicting the presence/absence of somatostatin receptor 2 expression in insulinomas

“…Although this association is interesting, it is unclear whether there is a positive correlation between SSTR2 expression and glucose-stimulated insulin secretion. Additionally, since it has been reported that octreotide was effective in elderly patients with insulinoma [10,19,20], the relationship between SSTR2 expression and age is interesting. However, it is also unclear whether SSTR2 expression is correlated to age in our results.…”

67-jährige Patientin mit rezidivierenden Hypoglykämien

“…Das Nüchterninsulin im Serum beträgt 36,4 μE/ml (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) und das C-Peptid 4,68 ng/ml (0,78-1,89) bei einem Glucosewert von 37 mg/dl. Auf einen Fastentest wird aufgrund der niedrigen Nüchtern-blutzuckerwerte verzichtet.…”

“…Auch die in der Literatur oft als effektiv beschriebene Gabe von Somatostatinanaloga [10,13] erwies sich trotz des Nachweises von Somatostatinrezeptoren im Tumorgewebe nicht als effektiv, wenngleich natürlich noch weitere Dosissteigerungen möglich gewesen wären. Auf einen Behandlungsversuch mit Diazoxid, einer Substanz, die die Insulinsekretion reversibel verringert, haben wir in Anbetracht der möglichen Natriumretention und Ödemneigung verzichtet und einen chirurgischen Ansatz gewählt.…”