title: Medical treatment of benign insulinoma using octreotide LAR: a case report.
abstract: In some patients with insulinoma, surgery is not possible due to either difficulties in detecting the tumor or advanced age. These patients need medical treatment for hypoglycemia. We report a case of benign insulinoma using the long-acting octreotide formulation, octreotide long-acting repeatable (octreotide LAR), as a medical therapy. A 67-year-old woman was referred to our hospital for examinations of hypoglycemia. A blood sample taken during a hypoglycemic episode revealed low plasma glucose concentration, hyperinsulinemia and a high C-peptide level. An abdominal CT scan demonstrated a hypervascular tumor in the body of pancreas. She was diagnosed with insulinoma. As the patient refused surgical resection of the pancreas tumor, we started to use the somatostatin analogue, octreotide, for treatment of hypoglycemia. After the treatment her plasma glucose levels were elevated and serum immunoreactive insulin (IRI) levels were decreased. For long-term treatment, we changed the treatment from daily subcutaneous injection of octreotide to monthly intramuscular administration of octreotide LAR. This treatment was also effective and hypoglycemic attacks disappeared. Both plasma glucose levels and serum IRI levels were improved. Our case demonstrated that octreotide LAR was useful for long-term medical treatment of insulinoma.
authors.affiliation: Molecular Genetics of Cardiovascular Disorders, Graduate School of Medical Science, Kanazawa University, Japan.
authors.forename: Mikiya
authors.initials: M
authors.lastname: Usukura
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoneda
authors.forename: Nobushige
authors.initials: N
authors.lastname: Oda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takata
authors.forename: Kenkou
authors.initials: K
authors.lastname: Hasatani
authors.forename: Yoshiyu
authors.initials: Y
authors.lastname: Takeda
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis; D003692:Delayed-Action Preparations; D005260:Female; D006442:Glycated Hemoglobin; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000188:drug therapy* / Q000473:pathology; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D018931:Antineoplastic Agents, Hormonal; D001786:Blood Glucose; D003692:Delayed-Action Preparations; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D007328:Insulin; D015282:Octreotide; C517652:hemoglobin A1c protein, human