[Recurrent hypoglycemia caused by malignant insulinoma: chemoembolization as a therapeutic option].
METHODS
A 73-year-old previously healthy woman presented with recurrent weakness, vertigo and perioral paresthesia of 3 months' duration. Physical examination on admission was unremarkable and revealed a patient in good condition.


METHODS
Recurrent episodes of fasting hypoglycemia let us to proceed with a fasting test. The test was stopped after 24 hours when the patient became presyncopal and was found to have a blood sugar value of 2.2 mmol/l (accompanied by inadequately increased values for proinsulin, insulin and C-peptide). Ultrasound and computertomography of the abdomen showed a huge inhomogeneous mass in the tail of pancreas and multiple lesions in the liver, respectively. Core needle biopsies revealed typical histopathological findings of a neuroendocrine carcinoma.


METHODS
Eight cycles of chemotherapy were given using streptozotocin/doxorubicin for three cycles and streptozotocin/5-fluorouracil for the remaining therapy over a period of 16 months resulting in a reduction in size of liver metastases and improvement of symptoms. Following 6 months without any therapy new episodes of severe hypoglycemia and progression of the liver metastases occurred. Despite seven further cycles of chemotherapy and additional treatment with diazoxide/octreotide the patient remained hypoglycemic and continuous glucose infusions became necessary. Therefore, chemoembolization of the liver with streptozotocin/5-fluorouracil and lipiodol-emulsion was performed. This resulted in a significant improvement of symptoms and the patient could subsequently be discharged. The patient died 4 months later.


CONCLUSIONS
Chemoembolization is an effective possibility in the palliative treatment of advanced malignant insulinoma.
Schütt
M
M
Medizinische Klinik I, Universitätsklinikum Lübeck. morten.schuett@web.de
Lorch
H
H
Krüger
S
S
Klingenberg
R D
RD
Peters
A
A
Klein
H H
HH
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016461:Chemoembolization, Therapeutic / Q000379:methods; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007340:Insulinoma / Q000150:complications / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012008:Recurrence