Pasireotide as a Possible Tool for the Control of Refractory Hyperinsulinemic Hypoglycemia from Malignant Insulinoma

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Introduction: The control of hypoglycemic hyperinsulinemic syndrome from malignant insulinoma is challenging because it is often refractory to diazoxide and somatostatin analogues (SA). Everolimus can have side effects that can limit its use. Pasireotide, a multi-receptor-targeted SA with a high binding affinity to SSTR1 and SSTR5, exhibits a strong inhibitory effect of insulin secretion.

Aim(s): We present the case of a patient with refractory hypoglycemic syndrome from metastatic pancreatic NET treated with Pasireotide i.m. after the failure of different lines of treatment

Materials and methods: In 2013 a 60-yr old woman was diagnosed with a 15 mm non-functioning pancreatic NET with multiple liver metastases. (Ki67 10%). From 2013 to 2016 she underwent chemotherapy (STZ/5-FLU), 2 TACE of liver lesions, treatment with Everolimus 10 mg/day with Octreotide LAR 30 mg, and finally PRRT with 177Lu-octreotate. She developed a myelodyslpastic syndrome as a consequence of the treatments. In January 2017 she showed frequent hyperinsulinemic hypoglycemic episodes and was treated with diazoxide, which was stopped due to nausea and anorexia, octreotide LAR 30 mg, im glucagon and iv cortisone. Due to the persistence of severe hypoglycemic events she needed continuous iv 10% dextrose infusion. Given the pancytopenia, Everolimus could not be used again.

Conference: 15th Annual ENETSConcerence (2018)

Presenting Author: Davi' M

Authors: Zambon G, Cosaro E, Cingarlini S, Trombetta M, Landoni L,

Keywords: pasireotide, malignant insulinoma, hypoglycemia,