Usukura Mikiya, Yoneda Takashi, Oda Nobushige, Yamamoto Yasuhiro, Takata Hiroyuki, Hasatani Kenkou, Takeda Yoshiyu
Molecular Genetics of Cardiovascular Disorders, Graduate School of Medical Science, Kanazawa University, Japan.
Endocr J. 2007 Feb;54(1):95-101. doi: 10.1507/endocrj.k05-157. Epub 2006 Nov 24.
In some patients with insulinoma, surgery is not possible due to either difficulties in detecting the tumor or advanced age. These patients need medical treatment for hypoglycemia. We report a case of benign insulinoma using the long-acting octreotide formulation, octreotide long-acting repeatable (octreotide LAR), as a medical therapy. A 67-year-old woman was referred to our hospital for examinations of hypoglycemia. A blood sample taken during a hypoglycemic episode revealed low plasma glucose concentration, hyperinsulinemia and a high C-peptide level. An abdominal CT scan demonstrated a hypervascular tumor in the body of pancreas. She was diagnosed with insulinoma. As the patient refused surgical resection of the pancreas tumor, we started to use the somatostatin analogue, octreotide, for treatment of hypoglycemia. After the treatment her plasma glucose levels were elevated and serum immunoreactive insulin (IRI) levels were decreased. For long-term treatment, we changed the treatment from daily subcutaneous injection of octreotide to monthly intramuscular administration of octreotide LAR. This treatment was also effective and hypoglycemic attacks disappeared. Both plasma glucose levels and serum IRI levels were improved. Our case demonstrated that octreotide LAR was useful for long-term medical treatment of insulinoma.
在一些胰岛素瘤患者中，由于肿瘤难以检测或患者年事已高，无法进行手术。这些患者需要针对低血糖进行药物治疗。我们报告一例使用长效奥曲肽制剂——奥曲肽长效重复注射剂（奥曲肽LAR）作为药物治疗的良性胰岛素瘤病例。一名67岁女性因低血糖检查被转诊至我院。低血糖发作期间采集的血样显示血浆葡萄糖浓度低、高胰岛素血症和高C肽水平。腹部CT扫描显示胰腺体部有一个富血管肿瘤。她被诊断为胰岛素瘤。由于患者拒绝手术切除胰腺肿瘤，我们开始使用生长抑素类似物奥曲肽治疗低血糖。治疗后，她的血浆葡萄糖水平升高，血清免疫反应性胰岛素（IRI）水平降低。为进行长期治疗，我们将治疗方式从每日皮下注射奥曲肽改为每月肌肉注射奥曲肽LAR。这种治疗也有效，低血糖发作消失。血浆葡萄糖水平和血清IRI水平均得到改善。我们的病例表明，奥曲肽LAR对胰岛素瘤的长期药物治疗有用。
