*Department of Gastroenterology, Saitama Cancer Center, 818 Komuro, Ina, Kitaadachi-gun, Saitama 362-0806, Japan.
Jpn J Clin Oncol. 2014 Feb;44(2):186-90. doi: 10.1093/jjco/hyt193. Epub 2013 Dec 22.
Hypoglycemia poses a significant management challenge in patients with unresectable metastatic insulinoma. A 57-year-old woman with pancreatic neuroendocrine tumor with multiple liver metastases was referred to our institution. During the clinical course of pancreatic neuroendocrine tumor, she had experienced palpitations, cold sweats and faintness between meals that indicated her tumors had attained the characteristics of an insulinoma, and her quality of life was impacted by frequent hypoglycemic episodes which could not be prevented by conventional therapies. Shortly after the approval of everolimus for pancreatic neuroendocrine tumor in Japan, we began oral administration at 10 mg per day, which produced a rapid and substantial improvement in glycemic control. The serum insulin level decreased dramatically despite the tumor size remaining stable on computed tomography evaluation. Despite a dose reduction of everolimus to 5 mg per day in response to the adverse reaction of interstitial pneumonitis and a subsequent moderate increase in the serum insulin level, the patient has maintained normoglycemia for a year. Everolimus might represent the treatment of choice for unresectable insulinoma in terms of not only tumor stabilization but also glycemic control.
在无法切除的转移性胰岛素瘤患者中,低血糖症是一个重大的管理挑战。一位 57 岁女性患有胰腺神经内分泌肿瘤伴多发肝转移,被转介至我院。在胰腺神经内分泌肿瘤的病程中,她经历了餐后心悸、冷汗和晕厥,表明她的肿瘤已具有胰岛素瘤的特征,频繁的低血糖发作影响了她的生活质量,常规治疗无法预防。在依维莫司在日本被批准用于治疗胰腺神经内分泌肿瘤后不久,我们开始每天口服 10 毫克,这使得血糖控制迅速而显著改善。尽管 CT 评估肿瘤大小保持稳定,但血清胰岛素水平显著下降。尽管因间质性肺炎的不良反应将依维莫司剂量减少至每天 5 毫克,随后血清胰岛素水平中度升高,但患者已维持血糖正常 1 年。依维莫司不仅能稳定肿瘤,还能控制血糖,可能是无法切除的胰岛素瘤的治疗选择。