Managing Hypoglycaemia in Patients With Insulinoma-A Tertiary Centre Experience and Review of the Literature.

The management of hypoglycaemia is pivotal in the care of patients with insulinoma. Blood glucose monitoring and regulation needs careful attention pre- and peri-operatively for patients undergoing surgical resection and as part of the long-term management for patients with inoperable or metastatic disease. Hypoglycaemia symptoms are frequently pervasive and disabling, with many patients showing impaired hypoglycaemia awareness that can lead to life-threatening severe hypoglycaemia. Herein, we review the literature and describe our tertiary centre experience in the mutli-disciplinary management of hypoglycaemia for patients with proven insulinomas. We propose a stepwise algorithm for the management of hypoglycaemia, stratified by localised versus metastatic disease. We discuss our strategy for the nutritional management of hypoglycaemia, reviewing the evidence for the use of cornstarch products and artificial nutrition. We discuss pharmacological management including diazoxide, somatostatin receptor antagonists (SSAs), everolimus and glucocorticoids, in addition to other therapeutic interventions such as peptide receptor radionuclide therapy (PRRT) and endoscopic ablation.