ECE2021 Eposter Presentations Pituitary and Neuroendocrinology (32 abstracts)
Management of malignant insulina
Nerea Egaña Zunzunegui , Cristina Elias Ortega , Inmaculada Venegas Nebreda , Ismene Bilbao Garay , Maite Aramburu Calafell , Cristina García Delgado , Jorge Rojo Alvaro , Maite Perez de Ciriza Cordeu , Alfredo Yoldi Arrieta & Miguel Maria Goena Iglesias
Donostia Unibertsitate Ospitalea, Donostia, Spain
Introduction
Malignant insulinoma is a rare pancreatic neuroendocrine tumor that accounts for only 10% of all cases of insulinoma. The clinical picture is characterized by the presence of severe hyperinsulinemic hypoglycaemic syndrome in a patient with pancreatic tumor with locoregional and/or distant metastases. Therapeutic management is challenging due to the need to control both hypoglycemic syndrome and tumor growth. Curative surgery is rarely applicable due to widespread metastases. We analyze clinico pathological characteristics, treatments and prognosis of 3 patients diagnosticated from 2009 to 2015.
Surgery was the first choice of treatment in all the cases but it was dismissed from surgeon. Glycaemic control was the therapeutic challenge in these patients. In case 2 the hypoglycemic was controlled with diazoxide and lanreotide LAR. The others needed corticosteroid therapy and high doses of diazoxide to avoid hypoglycemia. After somatostatin analog Everolimus was the first line treatment. Case 1 refused this therapy and case 2 took only for one month because of bad tolerance. Hepatic metastases embolization improve the glycemic control in case 1. Lu- DOTATE was not available in our center.
| CASE 1 | CASE 2 | CASE 3 | |
| SEX | Female | Female | Male |
| AGE | 37 | 37 | 77 |
| TUMOR SIZE | 4.5 | 5 | 5 |
| METASTASIS | Hepatic + lymph node | Hepatic + lymph node | Hepatic + lymph node |
| GLUCOSE | 10 | 42 | 38 |
| INSULINE | 86 | 38 | 40 |
| C PEPTIDE | 7.7 | 8.7 | 9.5 |
| PROINSULINE | > 100 | > 100 | > 100 |
| KI67 | 20% | > 20% | 5-10% |
| HYPOG TREATMENT | Diazoxide + Dexameta | Diazoxide | Diazoxide + Dexameta |
| SURGERY | No | No | No |
| S. ANALOGS | Lanreotide LAR | Lanreotide LAR | Lanreotide LAR |
| 2° LINE | Hepatic mets embolizat | Everolimus | Everolimus |
| 3° LINE | Temozola + Capecita | Sunitib | |
| SURVIVAL | 22 months | 26 months | 29 months |
Conclusion
Surgery is the unique curative treatment but is rarely applicable due to the widespread metastasis at diagnosis. The hypoglycemic syndrome is often refractory and decreased quality of life of these patients, in addition to medical treatment, debulking surgery or locoregional therapies can improve the symptoms control.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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