title: Therapies for the medical management of persistent hypoglycaemia in two cases of inoperable malignant insulinoma.
abstract: OBJECTIVE
  Hypoglycaemia poses a significant management challenge in patients with unresectable functional malignant insulinoma. Novel agents such as mammalian target of rapamycin (mTOR) inhibitors and radiolabelled peptides may be effective where there is failure of conventional therapy.
  
  
  METHODS
  We present the cases of two men diagnosed with inoperable malignant insulinoma and hepatic metastases who developed severe symptomatic hypoglycaemia, and review potential therapies for glycaemic support.
  
  
  METHODS
  Despite treatment with diazoxide, frequent oral carbohydrate, prednisolone and somatostatin analogue therapy, both men required hospital admission for treatment with continuous i.v. dextrose. Both were treated with Lutetium-177 octreotate. One man was also treated with everolimus, a mTOR inhibitor.
  
  
  RESULTS
  Use of Lutetium-177 octreotate, and in one case everolimus, successfully achieved normoglycaemia, facilitating safe discharge from hospital. Both men also had regression in the size and number of hepatic metastases.
  
  
  CONCLUSIONS
  Lutetium-177 octreotate and everolimus are options for managing hypoglycaemia due to unresectable malignant insulinoma when refractory to conventional supportive therapies.
authors.affiliation: Department of Endocrinology and Diabetes, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
authors.forename: Gregory S Y
authors.initials: GS
authors.lastname: Ong
authors.forename: David E
authors.initials: DE
authors.lastname: Henley
authors.forename: David
authors.initials: D
authors.lastname: Hurley
authors.forename: J Harvey
authors.initials: JH
authors.lastname: Turner
authors.forename: Phillip G
authors.initials: PG
authors.lastname: Claringbold
authors.forename: P Gerry
authors.initials: PG
authors.lastname: Fegan
mesh_terms: D000368:Aged; D000068338:Everolimus; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D007340:Insulinoma / Q000188:drug therapy*; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D000068338:Everolimus; C447941:lutetium Lu 177 dotatate; D015282:Octreotide; D020123:Sirolimus