Husni Hasan, Khan Sara A, Alghaieb Buraq, Abusamaan Mohammed S, Donner Thomas W, Hamrahian Amir H
Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University School of Medicine Baltimore Maryland USA.
Clin Case Rep. 2022 Mar 22;10(3):e05650. doi: 10.1002/ccr3.5650. eCollection 2022 Mar.
Insulinomas are rare neuroendocrine pancreatic tumors that can be associated with severe episodes of hypoglycemia, leading to significant morbidity and mortality. These tumors are often difficult to localize, and hypoglycemia control can be challenging since glucose levels can be resistant to conventional therapies. Pasireotide is a novel somatostatin analog with a high affinity to multiple somatostatin receptors. It has up to 40 times higher affinity for somatostatin receptor subtype 5 in comparison with octreotide, leading to a higher inhibition of insulin release from beta cells. There are few case reports regarding the use of pasireotide in refractory hyperinsulinemic hypoglycemia. We describe a challenging case of endogenous hyperinsulinemic hypoglycemia refractory to standard medical treatment, in which pasireotide was used. In this case, imaging studies and calcium stimulation testing failed to localize an insulin-secreting tumor in an 83-year-old woman. Glucose levels remained low despite treatment with diazoxide, verapamil, and octreotide, necessitating the use of IV dextrose solutions. After starting subcutaneous (SC) pasireotide 0.9 mg twice a day, there was a significant improvement in the frequency and severity of hypoglycemic events, allowing the patient to be discharged from the hospital without needing IV glucose support.
胰岛素瘤是一种罕见的胰腺神经内分泌肿瘤，可伴有严重的低血糖发作，导致显著的发病率和死亡率。这些肿瘤通常难以定位，而且由于血糖水平对传统治疗有抵抗性，控制低血糖具有挑战性。帕瑞肽是一种新型的生长抑素类似物，对多种生长抑素受体具有高亲和力。与奥曲肽相比，它对生长抑素受体亚型5的亲和力高多达40倍，从而对β细胞胰岛素释放的抑制作用更强。关于帕瑞肽用于难治性高胰岛素血症性低血糖的病例报告很少。我们描述了一例对标准药物治疗难治的内源性高胰岛素血症性低血糖的具有挑战性的病例，其中使用了帕瑞肽。在该病例中，一名83岁女性的影像学检查和钙刺激试验未能定位胰岛素分泌肿瘤。尽管使用了二氮嗪、维拉帕米和奥曲肽进行治疗，血糖水平仍保持较低，需要使用静脉葡萄糖溶液。在开始每天两次皮下注射0.9毫克帕瑞肽后，低血糖事件的频率和严重程度有了显著改善，使患者无需静脉葡萄糖支持即可出院。
