title: Intractable hypoglycaemia in a patient with advanced carcinoid syndrome successfully treated with hepatic embolization.
abstract: A male patient presented at the age of 54 years with metastatic pancreatic neuroendocrine tumour (NET). He was managed with interferon and multiple courses of MIBG therapy which controlled his disease for about seven years. He then developed symptomatic hypoglycaemia which resolved with the introduction of somatostatin analogue treatment and further therapeutic MIBG. However, three years later he was admitted to hospital with severe and intractable hypoglycaemia, which persisted despite treatment with dietary manipulation, diazoxide, long-acting octreotide injections, intravenous infusion of dextrose and octreotide and everolimus. Bland hepatic embolization was attempted as a last resort and resulted in prompt and dramatic improvement of his condition with no hypoglycaemia for five months. We recommend that hepatic embolization should be considered in patients with advanced and metastatic NETs accompanied by refractory hypoglycaemia, with the aim of symptomatic relief and palliation, and possibly some survival benefit.
authors.affiliation: Department of Endocrinology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester; UK.
authors.forename: Angelos
authors.initials: A
authors.lastname: Kyriacou
authors.affiliation: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester; UK.
authors.forename: Was
authors.initials: W
authors.lastname: Mansoor
authors.affiliation: Department of Radiology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester; UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lawrance
authors.affiliation: Department of Endocrinology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester; UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Trainer
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D000068338:Everolimus / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000628:therapy*; D008099:Liver / Q000601:surgery*; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000628:therapy*; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000097:blood*; D015282:Octreotide / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000097:blood*
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; D005947:Glucose; D015282:Octreotide