Abstract
A male patient presented at the age of 54 years with metastatic pancreatic neuroendocrine tumour (NET). He was managed with interferon and multiple courses of MIBG therapy which controlled his disease for about seven years. He then developed symptomatic hypoglycaemia which resolved with the introduction of somatostatin analogue treatment and further therapeutic MIBG. However, three years later he was admitted to hospital with severe and intractable hypoglycaemia, which persisted despite treatment with dietary manipulation, diazoxide, long-acting octreotide injections, intravenous infusion of dextrose and octreotide and everolimus. Bland hepatic embolization was attempted as a last resort and resulted in prompt and dramatic improvement of his condition with no hypoglycaemia for five months. We recommend that hepatic embolization should be considered in patients with advanced and metastatic NETs accompanied by refractory hypoglycaemia, with the aim of symptomatic relief and palliation, and possibly some survival benefit.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Valle JW, Eatock M, Clueit B, Gabriel Z, Ferdinand R, Mitchell S, 2014 A systematic review of non-surgical treatments for pancreatic neuroendocrine tumours. Cancer Treatm Rev 40: 376–389.
Hinchliffe E, Allcock RL, Mansoor W, Myers MA, 2011 A patient with a metastatic gastroenteropancreatic endocrine carcinoma causing hyperinsulinaemic hypoglycaemia and the carcinoid syndrome. Ann Clin Biochem 48: 579–583.
Usukura M, Yoneda T, Oda N, et al, 2007 Medical treatment of benign insulinoma using octreotide LAR: a case report. Endocr J 54: 95–101.
Rinke A, Muller H, Schade-Brittinger C, et al, 2009 Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 27: 4656–4663.
Ong GS, Henley DE, Hurley D, Turner JH, Claringbold PG, Fegan PG, 2010 Therapies for the medical management of persistent hypoglycaemia in two cases of inoperable malignant insulinoma. Eur J Endocrinol 162: 1001–1008.
Todd JF, Stanley SA, Roufosse CA, et al, 2003 A tumour that secretes glucagon-like peptide-1 and somatostatin in a patient with reactive hypoglycaemia and diabetes. Lancet 361: 228–230.
Thomas NJ, Brooke AM, Besser GM, 2013 Long-term maintenance of normoglycaemia using everolimus in a patient with disseminated insulinoma and severe hypoglycaemia. Clin Endocrinol (Oxf) 78: 799–800.
Yao JC, Shah MH, Ito T, et al, 2011 Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 364: 514–523.
van Schaik E, van Vliet EI, Feelders RA, et al, 2011 Improved control of severe hypoglycaemia with malignant insulinomas by peptide receptor radionuclide therapy. J Clin Endocrinol Metab 96: 3381–3389.
Harring TR, Nguyen NT, Goss JA, O’Mahony CA, 2011 Treatment of liver metastases in patients with neuroendocrine tumors: a comprehensive review. Int J Hepatol 2011: 154541.
Lawandowski RJ, Geschwind JF, Liapi E, Salem R, 2011 Transcatheter intraarterial therapies: rationale and overview. Radiology 259: 641–657.
Muro S, Nasu J, Harada R, et al, 2014 Prompt resolution of hypoglycaemia by hepatic transarterial embolization for malignant insulinoma with multiple liver metastases. Acta Med Okayama 68: 307–311.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kyriacou, A., Mansoor, W., Lawrance, J. et al. Intractable hypoglycaemia in a patient with advanced carcinoid syndrome successfully treated with hepatic embolization. Hormones 15, 118–121 (2016). https://doi.org/10.1007/BF03401411
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03401411