Endocrine Abstracts

Introduction: Everolimus is a drug selective inhibitor of mTOR and approved by the FDA in 2011 for treatment of neuroendocrine tumors of pancreatic origin unresectable. Our objective was to evaluate the efficacy and safety of everolimus in a patient with malignant pancreatic head insulinoma.

Case: This is a 31 year old man who complains of epigastric pain, dizziness, sweating and syncope related to exercise. During admission is objectively severe hypoglycemia (<20 mg/dl) requiring steroids and diazoxide to maintain normoglycemia. In the analyzes presented insulinemias inappropriately high (30.4–36.5 mU/ml), increased catecholamines, 5HIAA and hypertransaminemia. A abdomen magentic resonance show a lobulated injury in pancreatic head of 5×4×6 cm and multiple metastases in liver. In a laparotomy, we observed multiple interaortocavas gastroepiploic adenopathies, so we rejected the pancreatectomy. Histopathological examination revealed infiltration by neuroendocrine carcinoma type malignant insulinoma G2 (2 mit/10cga and Ki-67 >7%). A Ostreoscan was negative. Chemotherapy was discarded for the low mitotic index, also the somatostatin analogs for the negativity octrescan. Finally, we decided to treat the patient with two liver chemoembolization, followed by treatment with everolimus 10 mg/24 h.

Results: During follow-up of 2 year, the tumor masses have remained similar size and radiological appearance, without evidence of new injuries. Hypertransaminemia remained stable. The patient remained euglycemic without specific treatment, even dietetic, and performs a normal life. Tolerance drug has been good without important adverse reactions.

Conclusions: Everolimus is a new treatment for pancreatic neuroendocrine tumors, especially useful in patients with great local extension or metastasis, when the surgery is not curative. Is a targeted therapy with antiproliferative effect, what slows the hormonal release, resulting in our case a control of carbohydrate metabolism. It is therefore a drug to be considered in these tumors, because good results can be obtained, as is the case in our patient.