Document Detail

Malignant insulinoma with hepatic and pulmonary metastases associated with primary hyperparathyroidism. Case report and review of the literature.
MedLine Citation:
PMID:  20108468     Owner:  NLM     Status:  MEDLINE    
Malignant insulinomas are rare tumors (10% of insulinomas) that often present as mnulticentric macro nodules with multiple liver metastases before diagnosis. We report the case of a 55 year old female with a medical history of severe hypoglycemic attacks for two months. Blood tests showed a decreased value of glycemia (30 mg/dl) associated with increased insulin level (l6 microU/ml) and an increased glycemia/insulinemia ratio of 1.87 supporting the diagnosis of insulinoma. Abdominal CT showed a 1.5 cm mass localized in the head of the pancreas with disseminated hepatic tumors, confirmed as neuroendocrine metastases by biopsy (which proved the presence of a malignant insulinoma). Primary hyperparathyroidism was diagnosed based on mild elevation of calcium (10.4 mg/dl) associated with a high level of PTH (71.2 pg/ml). The coexistence of the two endocrinopathies suggested the presence of type 1 multiple endocrine neoplasia (MEN 1). Because of multiple hepatic masses and liver function impairment, surgery and hepatic artery embolization were not performed. Somatostatin analog therapy was started with symptomatic control in the beginning, but rapid loss of beneficial effect. Finally, systemic chemotherapy with doxorubicin was administered, but the disease was progressive and after three months we decided to stop it. The patient died at home after one month, probably in hypoglycemic coma.
A Albu; A Zirnea; O Georgescu; D Terzea; D Jinga; S Fica
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Journal of medicine and life     Volume:  1     ISSN:  1844-122X     ISO Abbreviation:  J Med Life     Publication Date:    2008 Apr-Jun
Date Detail:
Created Date:  2010-01-29     Completed Date:  2010-06-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101477617     Medline TA:  J Med Life     Country:  Romania    
Other Details:
Languages:  eng     Pagination:  210-7     Citation Subset:  IM    
Emergency University Elias Hospital, Endocrinology Department, Marasti nr. 17, Sect 1, Bucharest, Romania.
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MeSH Terms
Hyperparathyroidism, Primary / complications*
Insulinoma / complications,  secondary*
Liver Neoplasms / complications,  secondary*
Lung Neoplasms / complications,  secondary*
Middle Aged
Pancreatic Neoplasms / complications,  pathology*

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