title: Prompt resolution of hypoglycemia by hepatic transarterial embolization for malignant insulinoma with multiple liver metastases.
abstract: A 45-year-old female who presented with loss of consciousness and a cold sweat was found to have a pancreatic tumor and multiple liver metastases. Laboratory studies showed marked hypoglycemia and inappropriately elevated serum insulin, C-peptide, and serum tumor markers. Fine needle aspiration revealed Grade 3 small-cell type primary pancreatic neuroendocrine carcinoma. Consequently, the diagnosis of malignant insulinoma was made. Transarterial embolization (TAE) for hepatic metastases resulted in the reduction of tumor volume and prompt resolution of hypoglycemic attacks, whereas diazoxide and systemic chemotherapy had been ineffective for controlling blood glucose levels, and octreotide was unavailable due to the allergic effect. This case report highlights the potential usefulness of TAE for malignant insulinomas in the management of hypoglycemia.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Muro
authors.forename: Junichiro
authors.initials: J
authors.lastname: Nasu
authors.forename: Ryo
authors.initials: R
authors.lastname: Harada
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsubara
authors.forename: Asuka
authors.initials: A
authors.lastname: Nakarai
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Takehiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Uno
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D004358:Drug Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D017809:Fatal Outcome; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000150:complications*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary*; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000188:drug therapy; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin