A case of insulinoma effectively treated with low‐dose diazoxide

Yasuda, Atsushi; Seki, Toshiro; Kitajima, Natsumi; Baba, Tetsuya; Sasaki, Noriko; Kametani, Yoshie; Seki, Momoko; Tanaka, Kazuko; Oki, Masayuki

doi:10.1002/ccr3.3017

Cited by 7 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…18 Diazoxide, a non-diuretic benzothiadiazine, increases plasma glucose levels by activating the opening of pancreatic ß-cell potassium channels, inhibiting insulin secretion via agonism of alpha-adrenergic receptors on pancreatic ß-cells and increasing hepatic gluconeogenesis. 19,20 For this dog to require exogenous insulin, the normal pancreatic ß-cells and the neoplastic insulinoma cells must have stopped producing and secreting insulin. This case likely experienced non-neoplastic ß-cell atrophy exacerbated by medicationinduced insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

“…In summary, glucocorticoid glucose regulation is achieved by promoting hepatic gluconeogenesis, decreased glucose uptake and utilisation from skeletal muscle and adipose tissue, and regulation of glycogen metabolism to increase hepatic storage 18 . Diazoxide, a non‐diuretic benzothiadiazine, increases plasma glucose levels by activating the opening of pancreatic ß‐cell potassium channels, inhibiting insulin secretion via agonism of alpha‐adrenergic receptors on pancreatic ß‐cells and increasing hepatic gluconeogenesis 19,20 . For this dog to require exogenous insulin, the normal pancreatic ß‐cells and the neoplastic insulinoma cells must have stopped producing and secreting insulin.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Insulin therapy in a dog diagnosed with a metastatic insulin‐secreting neuroendocrine tumour

Kane¹,

Thompson²

2023

Vet Record Case Reports

View full text Add to dashboard Cite

A 10‐year‐old, male, neutered Jack Russell terrier cross presented for a 24‐hour history of ataxia and collapse, progressing to generalised seizures in hospital at which a severe hypoglycaemia (2.9 mmol/L; 3.5–6.7) and hyperinsulinaemia (122 mU/L; 5–40 mU/L) were documented. Fine‐needle aspirates taken from multiple hepatic masses confirmed the diagnosis of a neuroendocrine neoplasm and probable metastatic insulinoma. Initial medical treatment consisted of intravenous dextrose 5%, glucagon continuous‐rate infusion, prednisolone, diazoxide, S‐adenosylmethionine and silybin, and toceranib phosphate. Hyperglycaemia (16.9 mmol/L; 3.5–6.7 mmol/L) was documented 157 days after commencing therapy with consistent clinical signs of diabetes mellitus. All medical treatments for insulinoma were discontinued; however, the dog's hyperglycaemia persisted. Therefore, caninsulin therapy commenced at a starting dose of 0.25 IU/kg, and was gradually increased to 0.6 IU/kg in the morning and 0.5 IU/kg in the evening. The dog was treated with insulin for 140 days, before relapsing hypoglycaemia and hyperinsulinaemia, with subsequent euthanasia 320 days after the initial diagnosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Insulin therapy in a dog diagnosed with a metastatic insulin‐secreting neuroendocrine tumour

Kane¹,

Thompson²

2023

Vet Record Case Reports

View full text Add to dashboard Cite

show abstract

“…12 It also can be used safely and effectively, on a long term basis, when it cannot be localized or removed surgically and SSA represent a good alternative, specially used in patients who cannot undergo surgical intervention and when diazoxide is not recommended due to adverse effects or inefficacy. 12,[16][17][18] In cases of malignant insulinoma, SSA can also be considered first-line treatment because of their antiproliferative effect. Everolimus can be used for refractory hypoglycaemia and glucocorticoids are only used when better pharmacological options were not available.…”

Section: Discussionmentioning

confidence: 99%

Occult insulinoma after oesophagectomy for oesophageal cancer-diagnostic challenges

et al. 2021

View full text Add to dashboard Cite

Hypoglycaemia in the post-operative period is mainly iatrogenic (related to anti-hyperglycaemic drugs), but can be explained by an endogenous hyperinsulinemic state. In the context of previous gastrointestinal surgery, a form of dumping syndrome can mask hypoglycaemia from an underlying cause, such as an insulinoma. The authors present a clinical case of a male patient who underwent oesophageal surgery for an oesophago-gastric junction adenocarcinoma and developed hypoglycaemic symptoms in the post-operative period, caused by an undiagnosed insulinoma. This case report portraits the diagnostic investigation of a hypoglycaemia state in the post-operative period, narrowing to the workup of an endogenous hyperinsulinemic hypoglycaemia and provides a summary of insulinoma’s treatment. An insulinoma should always be considered in a patient with endogenous hyperinsulinemic hypoglycaemia, even with a history of oesophago-gastric surgery.

show abstract

“…Este es considerado como el medicamento inicial de elección para el tratamiento sintomático; en la mayoría de los pacientes ha sido usado por una corta duración, mientras se estudia la localización del tumor (73). Esta benzotiadiazina antihipertensiva actúa al inhibir la liberación de insulina mediante la apertura de los canales de potasio dependientes de ATP de las células beta pancreáticos (74), de esta forma promueve la glucogenólisis y aumenta la producción hepática de glucosa, con una efectividad de 47-50 %, administrada en 3-8 mg/kg/día en 2-3 dosis. Sus efectos secundarios son edema periférico (generalmente se añade un diurético), hirsutismo, trombocitopenia e insuficiencia renal (73).…”

Section: Diazóxidounclassified

Abordaje del insulinoma: revisión actualizada de la literatura

Castro Gomez,

Contreras Romero,

Afanador Jaimes

et al. 2024

Rev.ACE

View full text Add to dashboard Cite

Contexto: el insulinoma se origina en las células ? de los islotes pancreáticos, donde la liberación de insulina es autónoma, pues evita los mecanismos de contrarregulación. Hay varios mecanismos fisiopatológicos propuestos, basados en la presencia de variantes patogénicas germinales o somáticas. Objetivo: aportar información sobre etiopatogenia, genética, epidemiología, clínica, diagnóstico, estadificación, localización, tratamiento y pronóstico del insulinoma. Metodología: revisión de la literatura en la base de datos PubMed, Google académico y literatura gris utilizando los términos MeSH: “insulinoma”, “physiopathology”, “epidemiology“, “signs and symptoms”, “diagnosis”, “therapeutics”, “prognosis”, “gastro-enteropancreatic neuroendocrine tumor”, y revisión del listado de referencias bibliográficas (en “bola de nieve”) de los estudios seleccionados. Resultados: el insulinoma es el tumor neuroendocrino pancreático funcional más frecuente con una clínica inespecífica que debe ser considerado ante la presencia de síntomas adrenérgicos y neuroglucopénicos, para el cual hay una gama de herramientas diagnósticas que se deben usar de manera complementaria dada su sensibilidad limitada, y el tratamiento debe ser orientado de acuerdo con la caracterización y estadificación del tumor. Conclusiones: el diagnóstico del insulinoma se retrasa durante varios años dada su clínica inespecífica, a pesar de su comportamiento mayormente benigno, se asociado a gran morbilidad.

show abstract

A case of insulinoma effectively treated with low‐dose diazoxide

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 7 publications

References 15 publications

Insulin therapy in a dog diagnosed with a metastatic insulin‐secreting neuroendocrine tumour

Insulin therapy in a dog diagnosed with a metastatic insulin‐secreting neuroendocrine tumour

Occult insulinoma after oesophagectomy for oesophageal cancer-diagnostic challenges

Abordaje del insulinoma: revisión actualizada de la literatura

Contact Info

Product

Resources

About