Life-threatening hypoglycaemia due to insulinoma successfully treated with PRRT

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Introduction: Malignant insulinoma is an uncommon tumour that is usually accompanied by severe hypoglycaemia.

Aim(s): We describe 29-year-old woman with life-threatening hypoglycaemia in the course of insulinoma.

Materials and methods: Several weeks before diagnosis, the patient had the following symptoms: tingling of the lower limbs, lips and cheeks with weakness and increased sweating, concentration disorders. The symptoms intensified when she was hungry and after physical exercise, they subsided after consuming a sweet drink. After an incident of loss of consciousness secondary to hypoglycaemia, she was hospitalised in the endocrinology department. Biochemical tests confirmed the diagnosis of insulinoma. CT scan identified two hypervascular focal lesions up to 12 mm in the pancreas, numerous pathological peripancreatic, paraaortic and mesenteric lymph nodes, pathological lymph node in the left supraclavicular and many osteosclerotic bone lesions. 68Ga-DOTATATE (PET)/CT scan showed pathological tracer accumulation in all changes described in CT and in mediastinal lymph nodes. Due to persistent hypoglycaemia, the patient required a continuous glucose infusion. She failed initial treatment with short-acting somatostatin analogue with hypoglycaemic syncopal event. After diazoxide was added to the treatment, the patient could be discharged home, but episodes of hypoglycaemia recurred, and the patient was not able to function normally. She received four cycles of PRRT with cumulative dose of 29,6 GBq.

Conference:

Presenting Author:

Authors: Ledwon A, Michalik B, Kropinska A, Paliczka-Cieslik E, Blewaska A,

Keywords: insulinoma, sever hypoglycaemia, PRRT,