ECE2016 Guided Posters Clinical Case Reports (10 abstracts)
Endoscopic ultrasound-guided ethanol ablation therapy for pancreatic insulinoma: an unusual strategy
Adriana de Sousa Lages , Patrícia Oliveira , Isabel Paiva , Francisco Portela , Daniela Guelho , Luis Cardoso , Nuno Vicente , Diana Oliveira , Diana Martins , Mara Ventura & Francisco Carrilho
Coimbra Hospital and University Center, Coimbra, Portugal.
Introduction: Insulinomas are the most frequent cause of endogenous hypoglycaemia. 90 to 95% of these are benign. Surgical enucleation or resection is the standard treatment. Medical therapy focuses mainly on the use of diazoxide with few alternatives in patients with high surgical risk.
Case-report: Female patient, 89 years-old, non-diabetic, with previous history of acute myocardial infarction, stroke with motor sequelae, pacemaker carrier and severe aortic valve disease was admitted to the emergency department due to recurrent hypoglycaemia, especially in fasting, with 3 weeks of evolution; without associated weight gain or access to hypoglycaemic drugs.
During hospitalization, the patient maintained multiple daily episodes of hypoglycaemia unrelated to food intake that conditioned need to maintain continuous hypertonic dextrose infusion during nighttime and frequent oral feedings during daytime.
Laboratory workout revealed a glycaemia value of 38 mg/dl (<55 mg/dl), serum insulin of 10 UUI/ml (>3 UUI/ml) and C-peptide of 1.9 ng/ml (>0.6 ng/ml); no other abnormalities were detected. Abdominal CT identified a 12 mm hypervascular nodular lesion of the pancreatic body suggestive of insulinoma. Attending to the comorbidities and age, the patient was not approved for surgery and therapy with diazoxide was initiated to a maximum dose of 75 mg/day. The lack of success of medical therapy was related to the difficulty in drug dose titration by the risk of congestive heart failure.
Endoscopic ultrasound-guided ethanol ablation therapy was a viable solution and 0.6 ml of ethanol was injected by transgastric approach; no complications were registered.
No symptomatic episodes of hypoglycaemia were noted during 5 months-follow-up.
Conclusion: Ethanol ablation therapy of insulinomas is a minimally invasive alternative treatment with low complication rates although with little experience. In high risk patients, this may be one of the only feasible options with satisfactory clinical results and significant impact on quality of life and survival.
Volume 41
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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