Vezzosi Delphine, Bennet Antoine, Rochaix Philippe, Courbon Frédéric, Selves Jannick, Pradere Bernard, Buscail Louis, Susini Christiane, Caron Philippe
Department of Endocrinology, Hôpital Rangueil, Toulouse, France.
Eur J Endocrinol. 2005 May;152(5):757-67. doi: 10.1530/eje.1.01901.
We studied the efficacy of octreotide treatment on hypoglycaemia in patients with insulinoma and its relationships with Octreoscan scintigraphy and the presence of tumoral somatostatin receptors sst2A and sst5.
17 patients with insulinoma were evaluated using (i) evaluation of blood glucose, insulin and C-peptide during a short 100 mug octreotide test in fasting patients and/or treatment over 8 days-8 months with octreotide, (ii) Octreoscan scintigraphy and (iii) immunostaining of the tumor with anti-sst2A and anti-sst5.
Octreotide was effective on hypoglycaemia in 10/17 patients. Octreoscan scintigraphy detected 4/17 insulinomas. sst2A receptor was detected in 7/17 insulinomas and sst5 in 15/17 insulinomas. Octreotide was effective on hypoglycaemia in those seven patients with sst2A receptor-expressing insulinoma, and in three patients with undetectable sst2A receptor and detectable sst5; it was ineffective in six patients whose tumor expressed the sst5 receptor with undetectable sst2A and in one patient with undetectable sst2A and sst5 receptor.
Octreotide is an effective treatment of hypoglycaemia in more than 50% of patients with insulinoma. Detection of responsive patients was better based on a positive short test with subcutaneous octreotide than on the results of Octreoscan scintigraphy. Positive anti-sst2 receptor immunostaining is associated with efficacy of octreotide treatment, but does not account for all cases of responsiveness to octreotide. Expression of sst5 receptor does not appear to explain per se the efficacy of octreotide on sst2A-negative insulinomas.
我们研究了奥曲肽治疗胰岛素瘤患者低血糖的疗效及其与奥曲肽扫描闪烁显像以及肿瘤生长抑素受体sst2A和sst5表达的关系。
对17例胰岛素瘤患者进行了评估，方法包括：（i）在空腹患者中进行短时间100微克奥曲肽试验期间以及和/或用奥曲肽治疗8天至8个月期间评估血糖、胰岛素和C肽；（ii）奥曲肽扫描闪烁显像；（iii）用抗sst2A和抗sst5对肿瘤进行免疫染色。
奥曲肽对17例患者中的10例低血糖有效。奥曲肽扫描闪烁显像检测到17例胰岛素瘤中的4例。17例胰岛素瘤中7例检测到sst2A受体，15例检测到sst5受体。奥曲肽对7例表达sst2A受体的胰岛素瘤患者以及3例未检测到sst2A受体但检测到sst5受体的患者的低血糖有效；对6例肿瘤表达sst5受体但未检测到sst2A受体的患者以及1例未检测到sst2A和sst5受体的患者无效。
奥曲肽对超过50%的胰岛素瘤患者的低血糖是一种有效的治疗方法。基于皮下注射奥曲肽的短期试验结果来检测有反应的患者比基于奥曲肽扫描闪烁显像的结果更好。抗sst2受体免疫染色阳性与奥曲肽治疗的疗效相关，但不能解释所有对奥曲肽有反应的病例。sst5受体的表达本身似乎不能解释奥曲肽对sst2A阴性胰岛素瘤的疗效。
