ECE2023 Poster Presentations Endocrine-related Cancer (62 abstracts)
Severe insulin secretion by an inoperable metastatic insulinoma can be controlled by 177-Lu-DOTA-TATE radionuclide therapy: a case report
George Riley 1 , Cécile Creton 1 , Léa Demarquet 1 , Perrine Raymond 1 , Elodie Chevalier 1,2 , Aurélien Lambert 3 , Bruno Guerci 1 , Marc Klein 1 & Nicolas Scheyer 1
1University Hospital of Nancy, Endocrinology, Diabetology and Nutrition, Vandœuvre-lès-Nancy, France; 2University Hospital of Nancy, Nuclear Medicine, Vandœuvre-lès-Nancy, France; 3Lorraine Institute of Oncology, Vandœuvre-lès-Nancy, France
Introduction: Metastatic insulinoma is an extremely rare form of malignant insulinoma involving metastatic growth where classical surgical treatment is often impossible. Medical therapies are widely considered and reserved for those especially with inoperable insulinoma with the goals of reducing tumor size, but also of reducing hypoglycemic events either by acting directly on the insulinoma cells (reducing excess insulin secretion from the insulinoma cells or reducing tumor volume), by decreasing sensitivity to insulin or by directly increasing blood sugar levels (glucose perfusion, enteral nutrition). Ga-DOTATOC radionuclide imaging is widely used for insulinoma diagnosis, however, the equivalent therapeutic radionuclide Lu-DOTATATE is less commonly used.
Observation: We report the case of a 58 yo patient with no previous medical history hospitalized in our department for treatment of a malignant symptomatic secreting insulinoma with bone, liver and lymphatic metastasis. The patient presented a severe excess of insulin secretion leading to a rapid escalation in conventional therapy (DIAZOXIDE, calcium channel blockers, corticotherapy, mTOR inhibitors, second-generation somatostatin analogs, continuous enteral nutrition and continuous glucose perfusion) that struggled to maintain blood sugar levels above 50 mg/dl. Tests for germline mutations and somatic mutations were negative and four months of intensive conventional treatment lead to no clinical or morphological success. However, after observing good 68-Ga-DOTATOC uptake, peptide receptor radionuclide therapy was proposed using 177-Lu-DOTA-TATE. The first single dose of 7400 MBq was extremely effective on insulin secretion allowing the discontinuation of DIAZOXIDE, mTOR inhibitors and G30% glucose perfusion as well as significant reduction in enteral nutrition and corticotherapy. The clinical tolerance of the treatment was excellent and did not cause initial excess insulin release.
Discussion: Radionuclide therapy by 177-Lu-DOTA-TATE was an effective and well tolerated treatment in this patient presenting secreting inoperable malignant insulinoma and could be considered in other patients in similar situations presenting hypoglycemia despite conventional treatment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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