Insulinomas are the most common functioning neuroendocrine tumours of the pancreas. Hypoglycemia due to excessive production of insulin is a main feature of this disease. Usually these neoplasms are benign and single with surgical excision as a treatment of choice. About 10% are malignant with tendency to form metastases especially to the liver then therapy requires various medical technics.
43 years old female with reccurent syncopies in course of hypoglycemia was admitted to the hospital to be diagnosed. Having suspected pathology within the pancreas the abdominal MRI was performed. It showed presence of numerous metastatic changes in the liver with no any other deviations in the abdomen including pancreas. Subsequent 18FDG PET-CT revealed metastases to the regional lymph nodes and the liver and suggested the presence of a primary lesion in the tail of the pancreas which was confirmed in EUS. Surgical excision of the tail of the pancreas was done. Pathological result: pancreatic neuroendocrine well differetiated cancer. Due to the recurrence of hypoglycemia patient was admitted to Department of Endocrinology where somatostatin analogue scintigraphy showed the presence of tracer accumulation foci in the liver. Combined long-acting somatostatin analogue (octreotide) and peptide radionuclide receptor ((90)Y-DOTA-TATE) therapy were introduced. Stable blood glucose levels with no tendency to hypoglycemia and partial regression (PR) of liver lesions according to RECIST citeria were observed in course of the treatment.
Combined octreotide and peptide receptor radionuclide therapy ((90)Y-DOTA-TATE) in case of malignant insulinoma