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Review
. 2022 Apr 19:13:860614.
doi: 10.3389/fendo.2022.860614. eCollection 2022.

Pasireotide for Refractory Hypoglycemia in Malignant Insulinoma- Case Report and Review of the Literature

Sandrine Oziel-Taieb  1 , Jemima Maniry-Quellier  1 , Brice Chanez  1 , Flora Poizat  2 , Jacques Ewald  3 , Patricia Niccoli  1
Affiliations
Review

Pasireotide for Refractory Hypoglycemia in Malignant Insulinoma- Case Report and Review of the Literature

Sandrine Oziel-Taieb et al. Front Endocrinol (Lausanne). .

Abstract

Malignant insulinomas are functional neuroendocrine tumors of the pancreas and the primary cause of tumor-related hypoglycemia. Malignant insulinoma is rare and has a poor prognosis. We report a case of metastatic malignant insulinoma in a 64-year-old female patient with severe and refractory hypoglycemia. After several ineffective locoregional and systemic therapeutic lines for the secretory disease, the introduction of pasireotide, a second-generation somatostatin analog, provided an improved clinical and secretory evolution both quickly and sustainably, with an excellent safety profile. Pasireotide is an effective and well-tolerated therapy in the treatment of refractory hypoglycemia in metastatic insulinoma.

Keywords: malignant insulinoma; neuroendocrine tumor; pancreatic neuroendocrine cancer; pasireotide; refractory hypoglycemia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Nuclear Imaging. (A) 18F-FDG-PET/CT Oct 2018; (B) 18F-FDG-PET/CT Dec 2020; (C) Octreoscan Dec 2020.
Figure 2
Figure 2
Immunostaining for SSTR2 (A) and SSTR5 (B). Immunostaining of metastatic hepatic lesion shows high expression of SSTR2 and low expression of SSTR5.
Figure 3
Figure 3
Hypoglycemia events per month since beginning of Pasireotide.
Figure 4
Figure 4
Radiological (MRI Diffusion) to CAPTEM and pasireotide. (A) June 2020, before CAPTEM; (B) December 2020, after 6 cycles of CAPTEM; (C) February 2022, pasireotide alone.
Figure 5
Figure 5
Timeline representing the anti-proliferative and anti-secretory treatments since diagnosis.
See this image and copyright information in PMC

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