Everolimus resolving hypoglycemia, producing hyperglycemia, and necessitating insulin use in a patient with diabetes and nonresectable malignant insulinoma.
OBJECTIVE
To present a case of management of refractory hypoglycemia due to malignant insulinoma with use of everolimus, resulting in recurrent insulin-requiring diabetes.


METHODS
This report describes a case of a nonresectable malignant insulinoma in a 78-year-old patient with long-standing type 2 diabetes mellitus. Endogenous hyperinsulinism was confirmed by a fasting test, which revealed a glucose level of 35 mg/dL and an insulin value of 23.7 μIU/mL. Endoscopic ultrasonography, magnetic resonance imaging, and computed tomography identified a pancreatic mass, infiltration of the superior mesenteric vein, and metastatic lesions in the liver.


RESULTS
After chemoembolization of the metastatic lesions, hypoglycemia recurred, despite combined treatment with somatostatin analogues, dexamethasone, and diazoxide. Everolimus, an orally administered mammalian target of rapamycin, was used at a daily dose of 5 mg. After 6 months, the hypoglycemia was controlled, and the patient presented with a C-peptide level of 0.2 ng/mL and secondary hyperglycemia that necessitated insulin treatment.


CONCLUSIONS
The orally administered drug everolimus controlled hypoglycemia due to a malignant insulinoma in a patient with prior insulin-requiring diabetes. Secondary hyperglycemia was an acceptable drug effect (to the patient and managing physicians), in light of the complex and often poorly tolerated treatments available for this rare condition.
Endocrinology and Nutrition Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. ferrer_juagar@gva.es
Juan C
JC
Ferrer-García
Mercedes
M
Tolosa-Torréns
Cristina
C
Hernando-Meliá
Luis
L
Arribas-Palomar
Carlos
C
Sánchez-Juan
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D000068338:Everolimus; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000188:drug therapy*; D007003:Hypoglycemia / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007340:Insulinoma; D008297:Male; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D007328:Insulin; D000068338:Everolimus; D020123:Sirolimus