Akademik Veri Yönetim Sistemi
25th European Congress of Endocrinology, İstanbul, Türkiye, 13 - 16 Mayıs 2023, ss.712
Introduction: Surgical removal of the tumor is the primary treatment modality for insulinomas. However, in some patients, surgery is not possible. Octreotide, a somatostatin analogue, is known to suppress insulin secretion. However, there are little data on the use of octreotide in the treatment of insulinoma. Here, we present an insulinoma patient with severe clinical findings and successful control of hypoglycemia after long-acting octreotide.
Case: A 71-year-old male patient with hypertension was admitted to our clinic with long-standing hypoglycemia. He had frequent (1-2 times a day) neuroglycopenia symptoms, especially during fasting. He described that he detected glucose values below 40 mg/dl almost every day. Laboratory tests were as follows: fasting plasma glucose 23 mg/dl, insulin 34 mU/l, c-peptide 5 mg/l. Hospitalization was planned for further examination. At the 120th minute of the prolonged fasting test, capillary blood sugar was 39 mg/dl, plasma glucose was 33 mg/dl, insulin was 13.3 mU/l, c-peptide level was 3.1, and cortisol level was 14.5 mg/dl. Continuation of the test was not considered necessary, and 1 mg of glucagon was administered. Plasma glucose increased to 91 mg/dl at the 30th minute after glucagon. The patient, who was diagnosed with endogenous hyperinsulinism, was found to have negative insulin antibodies. Abdominal tomography revealed a 13x10 mm hypervascular lesion in the tail of the pancreas. The patient was diagnosed with insulinoma, and the operation was planned. He had episodes of severe hypoglycemia, and dextrose infusion was started. The patient was screened for multiple endocrine neoplasia, and no such finding was found. The importance of the operation was explained, however, the patient did not accept the surgical procedure. Under these circumstances, octreotide treatment was given at a dose of 3x50 mg for five days. Hypoglycemia did not recur, and dextrose infusion was interrupted. Monthly administration of octreotide LAR was planned, considering patient compliance. The patient who received octreotide LAR 10 mg and did not have hypoglycemia in the follow-up was discharged with the recommendation of frequent self-monitoring of blood glucose. His blood glucose monitoring at home ranged from 82 to 145 mg/dl. No hypoglycemia or complication was detected in the patient’s subsequent outpatient follow-ups.
Conclusions: In patients with insulinoma who are unsuitable for surgery, long-acting octreotide formulation may be an effective therapy, even at low doses.