Successful Treatment with Everolimus of Functioning Liver Metastases From a Pancreatic Insulinoma

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Introduction: Medical treatment of metastatic insulinoma is debated.

Aim(s): To test the efficacy of Everolimus on insulin secretion by liver metastases of a pancreatic insulinoma.

Materials and methods: The patient (66 yrs old) was admitted due to hypoglycemic crises. Glucose=35 mg/dl, insulin =94.9 mUI/l, HbA1c= 4.5% and C peptide =11.1 ng/ml suggested an insulinoma. Abdominal CT showed a 1.5 cm nodule of the head of the pancreas and six metastatic liver nodules. Liver biopsy showed metastases of well-differentiated neuroendocrine carcinoma, G2. The patient underwent a total pancreasectomy with removal of a portion of the gastric wall, spleen, duodenum, gallbladder, right liver lobe. Histology showed a pancreatic well-differentiated neuroendocrine carcinoma, Ki-67= 4%, infiltrating the peri-pancreatic adipose tissue, with metastases to the gastric lymphodes and to the liver. One month after angio-US showed the presence of at least six liver mestastases in the residual left liver, not suitable for radiofrequency ablation. Hypoglycemia recurred, indicating the persistence of insulin production by the metastatic liver in keeping with measurable insulin and C-peptide plasma levels. The patient then started compassionate treatment with Everolimus (10 mg/day).

Conference: 9th Annual ENETSConcerence (2012)

Presenting Author:

Authors: Zatelli M, Ambrosio M, Franceschetti P, Lunardon S, Bondanelli M,

Keywords: Everolimus, insulinoma,