Department of Endocrinology and Diabetes, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
Eur J Endocrinol. 2010 May;162(5):1001-8. doi: 10.1530/EJE-09-1010. Epub 2010 Feb 17.
Hypoglycaemia poses a significant management challenge in patients with unresectable functional malignant insulinoma. Novel agents such as mammalian target of rapamycin (mTOR) inhibitors and radiolabelled peptides may be effective where there is failure of conventional therapy.
We present the cases of two men diagnosed with inoperable malignant insulinoma and hepatic metastases who developed severe symptomatic hypoglycaemia, and review potential therapies for glycaemic support.
Despite treatment with diazoxide, frequent oral carbohydrate, prednisolone and somatostatin analogue therapy, both men required hospital admission for treatment with continuous i.v. dextrose. Both were treated with Lutetium-177 octreotate. One man was also treated with everolimus, a mTOR inhibitor.
Use of Lutetium-177 octreotate, and in one case everolimus, successfully achieved normoglycaemia, facilitating safe discharge from hospital. Both men also had regression in the size and number of hepatic metastases.
Lutetium-177 octreotate and everolimus are options for managing hypoglycaemia due to unresectable malignant insulinoma when refractory to conventional supportive therapies.
在无法切除的功能性恶性胰岛素瘤患者中，低血糖症是一个重大的管理挑战。新型药物，如哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂和放射性标记肽，在常规治疗失败时可能有效。
我们报告了两名被诊断为不可切除的恶性胰岛素瘤和肝转移的男性患者，他们出现严重的症状性低血糖，并回顾了血糖支持的潜在治疗方法。
尽管接受了二氮嗪、频繁口服碳水化合物、泼尼松龙和生长抑素类似物治疗，但这两名男性均因需要持续静脉输注葡萄糖而住院治疗。两人均接受了镥-177 奥曲肽治疗。一名男性还接受了 mTOR 抑制剂依维莫司治疗。
使用镥-177 奥曲肽，在一个病例中还使用了依维莫司，成功地实现了血糖正常化，从而安全出院。两名男性的肝转移瘤的大小和数量也都有所缩小。
当无法切除的恶性胰岛素瘤引起的低血糖症对常规支持治疗产生抗药性时，镥-177 奥曲肽和依维莫司是治疗的选择。
