Abell Sally K, Teng Jessie, Dowling Anthony, Hofman Michael S, MacIsaac Richard J, Sachithanandan Nirupa
Department of Endocrinology and Diabetes , St Vincent's Hospital , PO Box 2900, Fitzroy, Melbourne, 3065 Victoria , Australia.
Department of Oncology , St Vincent's Hospital , PO Box 2900, Fitzroy, Melbourne, 3065 Victoria , Australia.
Endocrinol Diabetes Metab Case Rep. 2015;2015:140097. doi: 10.1530/EDM-14-0097. Epub 2015 Jan 1.
This paper details the case of a 77-year-old male with refractory hypoglycaemia due to inoperable metastatic pancreatic neuroendocrine tumour (pNET) co-secreting insulin and gastrin. Multiple medical therapies were trialled with limited success, and we describe the complications experienced by our patient. Somatostatin analogues can ameliorate hypoglycaemia and may have tumour-stabilising effects; however, in our case resulted in paradoxical worsening of hypoglycaemia. This rendered our patient hospital dependent for glycaemic support including continuous dextrose infusion. Although this is a reported adverse effect with initiation of therapy, we describe successful initiation of short-acting octreotide as an inpatient followed by commencement of long-acting octreotide. Hypoglycaemic collapse occurred only after dose titration of long-acting octreotide. We outline the pitfalls of somatostatin analogue therapy and the mechanisms that may contribute to worsening hypoglycaemia. This rare side effect cannot be reliably predicted, necessitating close supervision and glucose monitoring during therapy. Our patient achieved disease stabilisation and gradual resolution of hypoglycaemia with peptide receptor radionuclide therapy (PRRT), an emerging therapeutic option for metastatic neuroendocrine tumours with high efficacy and low toxicity. We present a brief but comprehensive discussion of currently available and novel therapies for insulin secreting pNETs.
Hypoglycaemia due to malignant insulin secreting pNET is frequently severe and may be life-threatening despite supportive therapies.Octreotide can ameliorate hypoglycaemia, and may have anti-proliferative and tumour-stabilising effects in malignant pNETs that are surgically unresectable.Paradoxical worsening of hypoglycaemia may occur with octreotide initiation and dose titration, necessitating close supervision and glucose monitoring.PRRT is emerging as a therapeutic option with high efficacy and low toxicity.
本文详细介绍了一名77岁男性患者的病例，该患者因无法手术的转移性胰腺神经内分泌肿瘤（pNET）同时分泌胰岛素和胃泌素而出现难治性低血糖。尝试了多种药物治疗，但效果有限，我们描述了患者所经历的并发症。生长抑素类似物可改善低血糖，可能具有肿瘤稳定作用；然而，在我们的病例中，却导致低血糖反而恶化。这使得我们的患者因血糖支持而依赖住院治疗，包括持续输注葡萄糖。虽然这是治疗开始时报告的一种不良反应，但我们描述了患者住院期间成功开始使用短效奥曲肽，随后开始使用长效奥曲肽。仅在长效奥曲肽剂量滴定后才发生低血糖昏迷。我们概述了生长抑素类似物治疗的陷阱以及可能导致低血糖恶化的机制。这种罕见的副作用无法可靠预测，因此在治疗期间需要密切监测和血糖监测。我们的患者通过肽受体放射性核素治疗（PRRT）实现了疾病稳定和低血糖的逐渐缓解，PRRT是一种新兴的转移性神经内分泌肿瘤治疗选择，具有高效和低毒的特点。我们简要而全面地讨论了目前可用的以及针对分泌胰岛素的pNET的新型疗法。
恶性胰岛素分泌性pNET导致的低血糖通常很严重，尽管有支持性治疗，仍可能危及生命。奥曲肽可改善低血糖，对无法手术切除的恶性pNET可能具有抗增殖和肿瘤稳定作用。奥曲肽开始使用和剂量滴定可能会出现低血糖反而恶化的情况，因此需要密切监测和血糖监测。PRRT正成为一种高效低毒的治疗选择。
