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Case Reports
. 2023 Jan 27;10(1):e00954.
doi: 10.14309/crj.0000000000000954. eCollection 2023 Jan.

Malignant Insulinoma Arising From Nonfunctioning Pancreatic Neuroendocrine Tumor

Ritodhi Chatterjee  1 , Basim Ali  1 , Son H Nguyen  2 , Rui Chen  2 , Yvonne H Sada  3
Affiliations
Case Reports

Malignant Insulinoma Arising From Nonfunctioning Pancreatic Neuroendocrine Tumor

Ritodhi Chatterjee et al. ACG Case Rep J. .

Abstract

Pancreatic neuroendocrine tumors are rare neoplasms characterized into nonfunctioning (NF-PNET) and functioning (F-PNET) subtypes. F-PNETs typically involve overt symptoms related to excessive hormone secretion but may rarely present first as NF-PNETs with delayed transformation. We present a patient with known NF-PNET with liver metastases who developed hypoglycemia 2 years after initial diagnosis due to malignant insulinoma. Hypoglycemia was refractory to continuous dextrose but improved temporarily after diazoxide and hepatic artery embolization. Malignant insulinomas are usually metastatic at presentation and portend poor prognosis. Hypoglycemia may be medically managed with steroids, somatostatin analogues, and diazoxide, along with therapies to reduce tumor burden.

Keywords: diazoxide; hepatic artery embolization; insulinoma; liver metastases; pancreatic neuroendocrine tumor.

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Figures

Figure 1.
Figure 1.
T2-weighted axial magnetic resonance images demonstrating greater than 40 diffuse hepatic metastases, the largest measuring 8.5 × 5.3 cm in segment 5/6 and 6.2 × 6.9 cm in the right hepatic dome. Porta hepatis nodal conglomerate measuring 3.9 cm is also noted.
Figure 2.
Figure 2.
Scatter plot of inpatient blood glucose measurements. The blue line marks 70 mg/dL, the lower bound of normal at our institution. D10 infusion was initiated on day 1, D20 on day 16, and D50 on day 18. Diazoxide was initiated, and the patient underwent hepatic artery embolization on day 22. Dextrose supplementation was discontinued on day 25.
See this image and copyright information in PMC

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