Department of Endocrinology and Metabolic diseases, CHU Larrey, Toulouse Cedex 9, France.
J Endocrinol Invest. 2011 Oct;34(9):e253-8. doi: 10.3275/7762. Epub 2011 May 27.
Preventing hypoglycemia is of vital importance and a major challenge in patients with severe symptomatic hypoglycemia related to malignant unresectable insulinomas, but there is no consensus treatment.
Five patients with malignant unresectable insulinomas were referred to our department for severe hypoglycemia. At referral the five patients were dependent on iv infusion of glucose solution. Patient 1 had a locally invasive 5-cm insulinoma, patients 2, 3 and 4 had multiple liver metastases and patient 5 had a 2.5-cm pancreatic tumor with multiple liver and lung metastases. Before referral to our department, 4/5 patients had been administered systemic chemotherapy and 3/5 therapeutic doses of radiolabeled octreotide without any benefit on blood glucose levels. Octreoscan scintigraphy was positive in 4 patients (patients 1-4). Diazoxide alone or combined with glucocorticoids had failed to control hypoglycemia. Continuous sc administration of octreotide (up to 1500 μg/day) resulted in normalization of blood glucose levels in patient 1. Chemoembolization of liver metastases normalized blood glucose levels in patient 2, minimized hypoglycemia in patients 3 and 4, and normalized blood glucose levels in patient 5 when followed by subcutaneous administration of octreotide (2000 μg/day). Chemoembolization had to be repeated four times in patient 3 to control blood glucose levels.
Chemoembolization of liver metastases and high-dose octreotide in responsive patients (alone or combined with chemoembolization) can control severe hypoglycemia in patients with symptomatic malignant unresectable insulinomas; the efficacy of octreotide can be improved after chemoembolization of liver metastases.
预防低血糖对于因恶性不可切除胰岛素瘤导致严重症状性低血糖的患者至关重要，但目前尚无共识的治疗方法。
五例恶性不可切除胰岛素瘤患者因严重低血糖被转至我科。转来我院时，五例患者均依赖静脉输注葡萄糖溶液。患者 1 有局部侵袭性 5cm 胰岛素瘤，患者 2、3 和 4 有多发性肝转移，患者 5 有 2.5cm 胰腺肿瘤，伴多发肝、肺转移。在转至我科之前，4/5 例患者已接受全身化疗和 3/5 例放射性标记奥曲肽治疗，但血糖水平均无改善。4 例患者（患者 1-4）奥曲肽扫描阳性。单独使用二氮嗪或联合使用糖皮质激素未能控制低血糖。连续皮下给予奥曲肽（高达 1500μg/天）可使患者 1 的血糖水平正常化。肝转移化疗栓塞使患者 2 的血糖水平正常化，使患者 3 和 4 的低血糖最小化，并使患者 5 的血糖水平在皮下给予奥曲肽（2000μg/天）后正常化。患者 3 需重复化疗栓塞四次以控制血糖水平。
对于有反应的患者（单独或联合化疗栓塞），肝转移化疗栓塞和高剂量奥曲肽可控制有症状的恶性不可切除胰岛素瘤患者的严重低血糖；肝转移化疗栓塞后奥曲肽的疗效可提高。
