Management of intractable hypoglycemia with Yttirum-90 radioembolization in a patient with malignant insulinoma.
Metastatic insulinomas may present with recurrent life-threatening hypoglycemia. Treatment of hypoglycemia in such patients is difficult and frequently fails to respond to numerous therapeutic agents, requiring continuous dextrose infusion. The authors present our experience with Yttirum-90 radioembolization in a patient with metastatic malignant insulinoma who failed to respond to distal pancreatectomy, systemic chemotherapy with capecitabine and everolimus and medical treatment with somatostatin analogues, diazoxide and corticosteroids. Treatment with repeated Y-90 radioembolization resulted in rapid resolution of hypoglycemic events, allowing discontinuation of dextrose infusion and hospital discharge. However, the effect of Y-90 administration seems to be transient and without evidence of tumor shrinkage in imaging studies.
Chandra
Prakash
P
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Yarandi
Shadi Sadeghi
SS
Khazai
Natasha
N
Jacobs
Sol
S
Umpierrez
Guillermo E
GE
D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007340:Insulinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011877:Radionuclide Imaging; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D015021:Yttrium Radioisotopes