Document Detail


Therapies for the medical management of persistent hypoglycaemia in two cases of inoperable malignant insulinoma.
MedLine Citation:
PMID:  20164213     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Hypoglycaemia poses a significant management challenge in patients with unresectable functional malignant insulinoma. Novel agents such as mammalian target of rapamycin (mTOR) inhibitors and radiolabelled peptides may be effective where there is failure of conventional therapy. DESIGN: We present the cases of two men diagnosed with inoperable malignant insulinoma and hepatic metastases who developed severe symptomatic hypoglycaemia, and review potential therapies for glycaemic support. METHOD: Despite treatment with diazoxide, frequent oral carbohydrate, prednisolone and somatostatin analogue therapy, both men required hospital admission for treatment with continuous i.v. dextrose. Both were treated with Lutetium-177 octreotate. One man was also treated with everolimus, a mTOR inhibitor. RESULT: Use of Lutetium-177 octreotate, and in one case everolimus, successfully achieved normoglycaemia, facilitating safe discharge from hospital. Both men also had regression in the size and number of hepatic metastases. CONCLUSION: Lutetium-177 octreotate and everolimus are options for managing hypoglycaemia due to unresectable malignant insulinoma when refractory to conventional supportive therapies.
Authors:
Gregory S Y Ong; David E Henley; David Hurley; J Harvey Turner; Phillip G Claringbold; P Gerry Fegan
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-02-17
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  162     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-27     Completed Date:  2010-05-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1001-8     Citation Subset:  IM    
Affiliation:
Department of Endocrinology and Diabetes, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Humans
Hypoglycemia / drug therapy*
Insulinoma / drug therapy*
Liver Neoplasms / secondary
Male
Middle Aged
Octreotide / analogs & derivatives*,  therapeutic use
Organometallic Compounds / therapeutic use*
Pancreatic Neoplasms / drug therapy*
Radiopharmaceuticals / therapeutic use*
Sirolimus / analogs & derivatives*,  therapeutic use
Chemical
Reg. No./Substance:
0/(177lutetium-DOTA(O)Tyr3)octreotate; 0/Organometallic Compounds; 0/Radiopharmaceuticals; 159351-69-6/everolimus; 53123-88-9/Sirolimus; 83150-76-9/Octreotide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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