title: Management of malignant insulinoma.
abstract: OBJECTIVE
  Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists.
  
  
  OBJECTIVE
  To evaluate the results of multidisciplinary management of malignant insulinoma.
  
  
  METHODS
  Retrospective review of patients with malignant insulinoma treated from 1995 to 2011.
  
  
  RESULTS
  Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1.
  
  
  CONCLUSIONS
  Hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment.
authors: Department of Endocrinology and Nutrition, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors: J C
authors: JC
authors: Ferrer-García
authors: V
authors: V
authors: Iranzo González-Cruz
authors: S
authors: S
authors: Navas-DeSolís
authors: M
authors: M
authors: Civera-Andrés
authors: C
authors: C
authors: Morillas-Ariño
authors: A
authors: A
authors: Merchante-Alfaro
authors: C
authors: C
authors: Caballero-Díaz
authors: C
authors: C
authors: Sánchez-Juan
authors: C
authors: C
authors: Camps Herrero
mesh_terms: D000328:Adult; D000368:Aged; D016461:Chemoembolization, Therapeutic / Q000379:methods; D003981:Diazoxide / Q000627:therapeutic use; D000068338:Everolimus; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007340:Insulinoma / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014665:Vasodilator Agents; D015021:Yttrium Radioisotopes; D000068338:Everolimus; D003981:Diazoxide; D020123:Sirolimus