Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
J Clin Endocrinol Metab. 2011 Nov;96(11):3381-9. doi: 10.1210/jc.2011-1563. Epub 2011 Sep 14.
Insulinomas are relatively rare neuroendocrine tumors of the pancreas. Only 10% are considered malignant. Control of insulin hypersecretion and hypoglycemia in patients with malignant insulinomas may be extremely difficult. Different medications and chemotherapy schedules have been used.
Five patients with metastatic insulinomas and severe, poorly controllable, hypoglycemia are described. These patients required continuous glucose infusion to control severe hypoglycemia, which were induced by the high levels of insulin secretion. Conventional medications, such as diazoxide, or streptozotocin-based chemotherapies had been used to control hypoglycemia but were ineffective and/or produced adverse effects. All patients were treated with sc octreotide.
Peptide receptor radionuclide therapy with radiolabeled-somatostatin analogs was used.
After the start of radiolabeled somatostatin analog therapy, the five patients with metastatic insulinomas had stable disease for a mean period of 27 months. During these months, the patients were without any hypoglycemic episodes. Finally, three of five patients died because of progressive disease.
Radiolabeled somatostatin analog therapy can stabilize tumor growth and can be very successful in further controlling severe hypoglycemia in malignant insulinomas. In our series, this eventually resulted in improved survival outside the hospital setting.
胰岛素瘤是胰腺相对罕见的神经内分泌肿瘤，仅有 10%被认为是恶性的。恶性胰岛素瘤患者的胰岛素过度分泌和低血糖的控制可能极其困难。已经使用了不同的药物和化疗方案。
描述了 5 例转移性胰岛素瘤和严重、难以控制的低血糖患者。这些患者需要持续输注葡萄糖来控制严重的低血糖，这是由高水平的胰岛素分泌引起的。常规药物，如二氮嗪或基于链脲佐菌素的化疗，已被用于控制低血糖，但无效和/或产生不良反应。所有患者均接受 sc 奥曲肽治疗。
使用放射性标记的生长抑素类似物进行肽受体放射性核素治疗。
在开始放射性标记生长抑素类似物治疗后，5 例转移性胰岛素瘤患者的疾病平均稳定 27 个月。在这些个月里，患者没有发生任何低血糖事件。最后，5 例患者中有 3 例因进展性疾病死亡。
放射性标记的生长抑素类似物治疗可以稳定肿瘤生长，并非常成功地进一步控制恶性胰岛素瘤的严重低血糖。在我们的系列中，这最终导致了院外生存的改善。
