Endocrine Abstracts

Case history: We have previously presented the case of a 31 year lady presenting with a seizure following exercise with a blood sugar of 1.4 mmol/l on a background of an 8 month history of episodic slurred speech, blurred vision and hunger relieved by eating in 2011.

Investigations: Investigations confirmed an insulinoma and imaging, including Ga⁶⁸ DOTATATE PET CT identified a lesion in the tail of the pancreas with multiple liver metastases. MEN1 testing did not reveal any mutation.

Results and treatment: She was treated with PRRT receiving 4 cycles of radiolabeled Y⁹⁰ DOTATATE therapy between August and November 2011. This resulted in a complete resolution of symptomatic hypoglycaemia. We now present 5 year follow up data.

Conclusions and points for discussion: She remains free of hypoglycaemia. Although she has suffered episodes of anxiety, capillary blood glucose monitoring has always remained normal. She has had annual MRI scans of the liver and pancreas which have shown stable changes. In 2017 she had a 5 year follow up Ga⁶⁸ DOTATATE PET CT scan the showed no somatostatin receptor avid lesions. The remaining stable lesions seen in the liver could represent scar tissue. She continues to have clinical follow up. This case illustrates that PRRT can result in long lasting remission of hypoglycaemia even in metastatic insulinoma as 5 years after treatment, and 4 years since this case was last presented, the patient has remained symptom and somatostatic receptor avid lesion free.