Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Am J Med Sci. 2010 Nov;340(5):414-7. doi: 10.1097/MAJ.0b013e3181ee7be2.
Metastatic insulinomas may present with recurrent life-threatening hypoglycemia. Treatment of hypoglycemia in such patients is difficult and frequently fails to respond to numerous therapeutic agents, requiring continuous dextrose infusion. The authors present our experience with Yttirum-90 radioembolization in a patient with metastatic malignant insulinoma who failed to respond to distal pancreatectomy, systemic chemotherapy with capecitabine and everolimus and medical treatment with somatostatin analogues, diazoxide and corticosteroids. Treatment with repeated Y-90 radioembolization resulted in rapid resolution of hypoglycemic events, allowing discontinuation of dextrose infusion and hospital discharge. However, the effect of Y-90 administration seems to be transient and without evidence of tumor shrinkage in imaging studies.
转移性胰岛素瘤可能表现为反复发作的危及生命的低血糖。此类患者的低血糖治疗较为困难，且经常对多种治疗药物无反应，需要持续输注葡萄糖。作者报告了一例转移性恶性胰岛素瘤患者的 Yttirum-90 放射性栓塞治疗经验，该患者对远端胰腺切除术、卡培他滨和依维莫司全身化疗以及生长抑素类似物、二氮嗪和皮质类固醇药物治疗均无反应。反复 Y-90 放射性栓塞治疗可迅速缓解低血糖事件，从而停止输注葡萄糖并出院。然而，Y-90 给药的效果似乎是短暂的，且影像学研究未显示肿瘤缩小的证据。
