Case report – Selective internal radiation therapy (SIRT) in a patient with hyperinsulinemic hypoglycemia due to a metastatic insulinoma with late onset of endocrine activity

Abstract

Insulinomas are the most common functioning pancreatic neuroendocrine tumors (NET), which can lead to hyperinsulinemic hypoglycemia. In advanced metastatic stages of the disease, the prognosis is poor. Patients with hormonally active insulinomas primarily present with features of neuroglycopenia. Transformation from a nonfunctional to a functional NET is rare. Here, we present a case of a 59-year-old male adult with a metastatic insulinoma and late onset of endocrine activity. Besides medical treatment with Diazoxide and small frequent feedings, continuous intravenous glucose application was eventually required to avoid hypoglycemia. Furthermore, we show that selective internal radiation therapy (SIRT) can be an effective therapeutic approach for symptom reduction in advanced metastatic disease.

Zusammenfassung

Insulinome gehören zu den häufigsten hormonaktiven neuroendokrinen Tumoren (NET) des Pankreas. Eine mögliche Komplikation stellt die hyperinsulinäme Hypoglykämie dar. Die Prognose im metastasierten Krankheitsstadium ist eingeschränkt. Patienten mit hormonproduzierenden Insulinomen werden klinisch meist mit Symptomen der Neuroglykopenie auffällig. Der Übergang eines nicht funktionellen NET in einen funktionellen NET ist selten. Wir stellen hier den Fall eines 59-jährigen Patienten mit metastasiertem Insulinom und Übergang in ein hormonaktives Stadium im späten Krankheitsverlauf vor. Trotz medikamentöser Therapie mit Diazoxid und häufigen kleinen Mahlzeiten war schließlich eine kontinuierliche intravenöse Glukosesubstitution notwendig, um Hypoglykämien zu vermeiden. Des Weiteren zeigen wir, dass die Selektive interne Radiotherapie (SIRT) eine mögliche Therapieoption zur Symptomkontrolle im metastasiertem Krankheitsstadium darstellt.

Schlüsselwörter

Darm - Gastro-entero-pankreatische Tumoren - Insulinom - SIRT - pNET - Hyperinsulinämie - Hypoglykämie

Keywords

gut - gastroentero-pancreatic tumors - insulinoma - SIRT - pNET - hyperinsulinemia - hypoglycemia

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