| Treatment with somatostatin analogues and chemoembolization of liver metastases for severe hypoglycemia in malignant insulinomas. | |
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MedLine Citation:
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PMID: 21623151 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background. Preventing hypoglycemia is of vital importance and a major challenge in patients with severe symptomatic hypoglycemia related to malignant unresectable insulinomas, but there is no consensus treatment. Patients. Five patients with malignant unresectable insulinomas were referred to our department for severe hypoglycemia. At referral the five patients were dependent on intravenous infusion of glucose solution. Patient 1 had a locally invasive 5-cm insulinoma, patients 2,3 and 4 had multiple liver metastases and patient 5 had a 2.5-cm pancreatic tumor with multiple liver and lung metastases. Before referral to our department, 4/5 patients had been administered systemic chemotherapy and 3/5 therapeutic doses of radiolabelled octreotide without any benefit on blood glucose levels. Octreoscan scintigraphy was positive in four patients (patients 1-4). Diazoxide alone or combined with glucocorticoids had failed to control hypoglycemia. Continuous subcutaneous administration of octreotide (up to 1500 μg/day) resulted in normalization of blood glucose levels in patient 1. Chemoembolization of liver metastases normalized blood glucose levels in patient 2, minimized hypoglycemia in patients 3 and 4, and normalized blood glucose levels in patient 5 when followed by subcutaneous administration of octreotide (2000 μg/day). Chemoembolization had to be repeated four times in patient 3 to control blood glucose levels. Conclusion. Chemoembolization of liver metastases and high-dose octreotide in responsive patients (alone or combined with chemoembolization) can control severe hypoglycemia in patients with symptomatic malignant unresectable insulinomas; the efficacy of octreotide can be improved after chemoembolization of liver metastases. |
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Authors:
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J C Maiza; D Vezzosi; S Grunenwald; P Otal; R Guimbaud; A Bennet; Ph Caron |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-5-27 |
Journal Detail:
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Title: Journal of endocrinological investigation Volume: - ISSN: 1720-8386 ISO Abbreviation: - Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-5-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7806594 Medline TA: J Endocrinol Invest Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Endocrinology and Metabolic diseases, CHU Larrey, Toulouse, France. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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