ECE2020 Audio ePoster Presentations Endocrine-related Cancer (14 abstracts)
Follow-up case report of an endoscopic ultrasound-guided ethanol ablation: An alternative option for the treatment of pancreatic insulinoma
Anna Vágvölgyi 1 , Rea Nagy 1 , Renáta Bor 1 , Anna Fábián 1 , Krisztián Sepp 1 , Sándor Hamar 2 , László Tiszlavicz 2 , Zoltán Szepes 1 & Zsuzsanna Valkusz 1
1University of Szeged, Faculty of Medicine, First Department of Internal Medicine, Szeged, Hungary; 2University of Szeged, Faculty of Medicine, Department of Pathology, Szeged, Hungary
Insulinomas are predominantly benign pancreatic neuroendocrine tumors presenting with hyperinsulinemic hypoglycemia. Patients with significant hypoglycemic episodes can pose a management challenge. Based on the extent and the aggressiveness of the disease patients may be offered different treatment regimens. Although surgical resection is currently the standard treatment for pancreatic insulinoma, alternative treatment options, such as endoscopic ultrasound-guided fine needle injection may be necessary for symptomatic patients who are not candidates for surgical resolution. We present the follow up history of a now 88-year-old woman who presented with a 10 year history of fasting hypoglycemia in 2013 and was diagnosed with an insulinoma. Considering her age and comorbidities, instead of surgical intervention she was started on diazoxide treatment. Later that year she underwent ultrasound-guided alcoholic ablation of her neuroendocrine tumor, the first such procedure reported in the Hungarian literature. After the intervention she did not require diazoxide therapy for a year. Because of the recurrence of asymptomatic fasting hypoglycemic episodes, diazoxide therapy was restarted at the end of 2014. She was hypoglycemia-free until the end of 2019, when she got admitted with repeated hypoglycemic episodes occurring during the night, despite diazoxide therapy. Endosonography revealed the progress of her pancreatic insulinoma and laboratory studies showed fasting hypoglycemia with hyperinsulinemia. Because of the continued high risk of surgical resection, the decision was made to proceed with another endoscopic ultrasound-guided alcohol injection. Following the intervention the patient was discharged without diazoxide therapy and did not show hypoglycemic tendency. This case history confirms that endoscopic ultrasound-guided alcoholic ablation can be a successful minimally invasive alternative treatment for patients with pancreatic neuroendocrine tumors in whom surgery is not feasible. Our case highlights that the major limitations of ultrasound-guided ethanol ablation are the possibility of late recurrence that would require retreatment, incomplete ablation and the risk of progression during the follow-up.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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