title: Insulinoma after streptozotocin therapy for metastatic gastrinoma: natural history or iatrogenic complication?
abstract: Islet cell carcinoma frequently produces more than one chemical product, although its clinical expression is usually restricted to a single hormone. We describe an unusual patient who presented with full-blown metastasizing gastrinoma. He was treated with cimetidine for five years and then streptozotocin therapy, which resulted in a regression in hepatomegaly and a fall in serum gastrin levels. Following one year's therapy with streptozotocin, he was admitted in hyperinsulinemic hypoglycemic stupor. This appears to be the first reported case of a "shift" from clinical gastrinoma to insulinoma possibly related to prolonged streptozotocin therapy.
authors.affiliation: Department of Medicine H, Tel Aviv Medical Center, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Bar
authors.forename: M
authors.initials: M
authors.lastname: Burke
authors.forename: A
authors.initials: A
authors.lastname: Isakov
authors.forename: C
authors.initials: C
authors.lastname: Almog
mesh_terms: D007516:Adenoma, Islet Cell / Q000139:chemically induced / Q000556:secondary; D000368:Aged; D015408:Gastrinoma / Q000188:drug therapy* / Q000556:secondary; D006801:Humans; D007340:Insulinoma / Q000139:chemically induced*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D010190:Pancreatic Neoplasms / Q000139:chemically induced* / Q000556:secondary; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000556:secondary; D013311:Streptozocin / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D013311:Streptozocin