O-09 A CASE OF INSULINOMA FOLLOWED BY MEDICAL TREATMENT WITH HIGH RISK OF SURGERY

Abstract

Listen

Translate article

Abstract Introduction Insulinoma is a rare neuroendocrine tumor originating from pancreatic beta cells. Insulinomas occur in 1-4 per million in the general population and represent 1-2% of all pancreatic neoplasms. They are usually sporadic but can also be associated with multiple neoplasia syndrome. The diagnosis of classical insulinoma depends on fulfillment of the Whipple triad criteria, which remain the cornerstone of the screening process: (1) hypoglycemia (plasma glucose < 50 mg/dL); (2) neuroglycopenic symptoms; and (3) immediate resolution of symptoms following glucose administration. A number of non-invasive techniques are available for localization of suspected insulinoma, including transabdominal ultrasonography, CT and/or MRI. Once localized, the first option is surgical treatment. In patients who are not suitable for surgical treatment, follow-up with medical treatment is required. Clinical Case An 84-year-old woman was admitted to the emergency department with dyspnea and was diagnosed as a COPD attack. During follow-up, sweating and palpitations were also present. It was determined that hypoglycemia was the cause of the patient's current clinic. The patient was internalized in our clinic to investigate the etiology of hypoglycemia. The patient's fasting blood results were glucose: 33 mg/dl, insulin: 16.2 Uu/ml, c peptide: 5.08 ng/mL and the blood results obtained at the time of neuroglucopenic symptoms were glucose: 49 mg/dl, insulin: 22 Uu/ml, c peptide 4.85 ng/mL. Abdominal CT and PET CT were planned with a prediagnosis of insulinoma. Abdominal CT was interpreted as “A hyperdense nodular lesion approximately 14 mm in size was noted in the body-tail section of the pancreas and was evaluated in favor of a neuroendocrine tumor in the first plan.” PET CT revealed a 9x10 mm solid nodule with low metabolic activity uptake (SUV Max: 3.11) at the pancreatic body/tail junction. We diagnosed the patient with insulinoma. We planned medical treatment for the patient with advanced stage COPD and heart failure because surgery was high risk. We started octreotide sc. 2x100 mcg treatment because there was a delay in the supply of diazoxide treatment. The patient's blood sugar normalized with this treatment. Hypoglycemia was not observed. After 1 week, diazoxide treatment was obtained. Diazoxide 3x50 mg was prescribed. The patient did not have hypoglycemia even with diazoxide treatment. Conclusion Insulinoma is a rare functional neuroendocrine tumor. Preoperative localization tests should be performed after biochemical diagnosis. The primary treatment is surgical resection. Diazoxide and somatostatin analogs may be used in lesions that cannot be removed surgically. In our case, we preferred medical treatment because surgery is high risk due to advanced stage COPD and heart failure. We observed the efficacy of medical treatment in managing hypoglycemia in our patient.