title: Improved control of severe hypoglycemia in patients with malignant insulinomas by peptide receptor radionuclide therapy.
abstract: BACKGROUND
  Insulinomas are relatively rare neuroendocrine tumors of the pancreas. Only 10% are considered malignant. Control of insulin hypersecretion and hypoglycemia in patients with malignant insulinomas may be extremely difficult. Different medications and chemotherapy schedules have been used.
  
  
  METHODS
  Five patients with metastatic insulinomas and severe, poorly controllable, hypoglycemia are described. These patients required continuous glucose infusion to control severe hypoglycemia, which were induced by the high levels of insulin secretion. Conventional medications, such as diazoxide, or streptozotocin-based chemotherapies had been used to control hypoglycemia but were ineffective and/or produced adverse effects. All patients were treated with sc octreotide.
  
  
  METHODS
  Peptide receptor radionuclide therapy with radiolabeled-somatostatin analogs was used.
  
  
  RESULTS
  After the start of radiolabeled somatostatin analog therapy, the five patients with metastatic insulinomas had stable disease for a mean period of 27 months. During these months, the patients were without any hypoglycemic episodes. Finally, three of five patients died because of progressive disease.
  
  
  CONCLUSIONS
  Radiolabeled somatostatin analog therapy can stabilize tumor growth and can be very successful in further controlling severe hypoglycemia in malignant insulinomas. In our series, this eventually resulted in improved survival outside the hospital setting.
authors.affiliation: Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van Schaik
authors.forename: E I
authors.initials: EI
authors.lastname: van Vliet
authors.forename: R A
authors.initials: RA
authors.lastname: Feelders
authors.forename: E P
authors.initials: EP
authors.lastname: Krenning
authors.forename: S
authors.initials: S
authors.lastname: Khan
authors.forename: K
authors.initials: K
authors.lastname: Kamp
authors.forename: R
authors.initials: R
authors.lastname: Valkema
authors.forename: F H
authors.initials: FH
authors.lastname: van Nederveen
authors.forename: J J M
authors.initials: JJ
authors.lastname: Teunissen
authors.forename: D J
authors.initials: DJ
authors.lastname: Kwekkeboom
authors.forename: W W
authors.initials: WW
authors.lastname: de Herder
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D007205:Indium Radioisotopes / Q000627:therapeutic use; D007340:Insulinoma / Q000150:complications*; D008187:Lutetium / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000150:complications*; D011868:Radioisotopes / Q000627:therapeutic use*; D013004:Somatostatin / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D007205:Indium Radioisotopes; D011868:Radioisotopes; D013004:Somatostatin; D008187:Lutetium; D015282:Octreotide