M. Schutt et al., Recurrent hypoglycemia caused by malignant insulinoma: Chemoembolization as therapeutical option, MED KLIN, 96(10), 2001, pp. 632-636
History and Clinical Findings: A 73-year-old previously healthy woman prese
nted with recurrent weakness, vertigo and perioral paresthesia of 3 months'
duration. Physical examination on admission was unremarkable and revealed
a patient in good condition.
Investigations: Recurrent episodes of fasting hypoglycemia let us to procee
d with a fasting test. The test was stopped after 24 hours when the patient
became presyncopal and was found to have a blood sugar value of 2.2 mmol/l
(accompanied by inadequately increased values for proinsulin, insulin and
C-peptide). Ultrasound and computertomography of the abdomen showed a huge
inhomogeneous mass in the tail of pancreas and multiple lesions in the live
r, respectively. Core needle biopsies revealed typical histopathological fi
ndings of a neuroendocrine carcinoma.
Treatment and Course: Eight cycles of chemotherapy were given using strepto
zotocin/doxorubicin for three cycles and streptozotocin/5-fluorouracil for
the remaining therapy over a period of 16 months resulting in a reduction i
n size of liver metastases and improvement of symptoms. Following 6 months
without any therapy new episodes of severe hypoglycemia and progression of
the liver metastases occurred. Despite seven further cycles of chemotherapy
and additional treatment with diazoxide/octreotide the patient remained hy
poglycemic and continuous glucose infusions became necessary. Therefore, ch
emoembolization of the liver with streptozotocin/5-fluorouracil and lipiodo
l (R) -emulsion was performed. This resulted in a significant improvement o
f symptoms and the patient could subsequently be discharged. The patient di
ed 4 months later.
Conclusion: Chemoembolization is an effective possibility in the palliative
treatment of advanced malignant insulinoma.