A case of insulinoma successfully treated by means of long-acting somatostatin analogue

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Introduction: Insulinoma is the most common hormonally active pancreatic neuroendocrine tumor. Effective treatment represents tumor surgery and medical therapy using diazoxide or streptozotocine. Somatostatin analogue therapy is rarely effective in this type of tumor.

Aim(s): We report on the case of a 66-year-old woman with insulinoma successfully treated by means of repeated injections of long-acting somatostatin analogue.

Materials and methods: She underwent the resection of the head and the body of pancreas, together with the spleen, in 1992. The symptoms of insulinoma returned following surgery and she was treated with diazoxide for about 15 years. She had hypoglycemia, with some episodes of hypoglycemic coma and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in diameter, which was localized in the head of the pancreas. Patient declined additional pancreatic surgery. Furthermore, we found other lesions in the left adrenal gland (14 mm in diameter) and in the right lung (8 mm in diameter). We revealed the presence of somatostatin receptors using somatostatin receptors scintigraphy (Octreoscan). Pheochromocytoma was diagnosed on the basis of higher levels of normetanephrine in 24-hour urine collection, and a higher level of norepinephrine in a blood sample. After the left adrenal gland was removed, we observed the normalization of blood pressure.

Conference: 7th Annual ENETSConcerence (2010)

Presenting Author: Bolanowski M

Authors: Jawiarczyk A, Bolanowski M, Syrycka J, Kolodziejczyk A,

Keywords: insulinoma, somatostatin analogue, octreoscan, diabetes mellitus,