title: Symptomatic control of hypoglycaemia with prednisone in refractory metastatic pancreatic insulinoma.
abstract: A 55-year-old female presented with recurring episodes of loss or decline in the quality of consciousness due to hypoglycaemia caused by insulin overproduction in hormonally active metastatic pancreatic insulinoma. All standard anticancer treatment modalities including chemotherapy, radiation, interferon alpha 2b, and lanreotide failed to achieve symptomatic control. The patient became dependent on continuous intravenous glucose supply. Based on anecdotal reports in literature, prednisone therapy was started in order to increase insulin resistance, reduce glucose utilization, increase hepatic glucose production, and impair insulin secretion. After 10 days of therapy, the patient was released from continuous intravenous glucose infusion. After several weeks, administration of prednisone was lowered to a daily maintenance dose of 2.5 mg with excellent symptomatic effects. In conclusion, prednisone therapy may be considered as a valid option to achieve symptomatic control in hormonally active therapeutically resistant insulinomas.
authors.affiliation: Department of Oncology, First Faculty of Medicine, General Teaching Hospital, Charles University, 128 08 Praha 2, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Novotny
authors.forename: Filip
authors.initials: F
authors.lastname: Janku
authors.forename: Pavel
authors.initials: P
authors.lastname: Mares
authors.forename: Lubos
authors.initials: L
authors.lastname: Petruzelka
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000000981:diagnostic imaging / Q000517:prevention & control*; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D011241:Prednisone / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: D018931:Antineoplastic Agents, Hormonal; D005938:Glucocorticoids; D011241:Prednisone