Off-label pasireotide treatment in one insulinoma patient with an atypical presentation and intolerant to diazoxide

Sileo, Federica; Cangiano, Biagio; Cacciatore, Chiara; Amarù, Jessica; Gatto, Federico; Albertelli, Manuela; Falconi, Massimo; Mantovani, Giovanna; Persani, Luca

doi:10.1007/s12020-020-02406-1

Cited by 6 publications

(7 citation statements)

References 15 publications

(16 reference statements)

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“…Subcutaneous PAS proved effective in controlling carcinoid symptoms in 27% of patients with advanced neuroendocrine tumors and carcinoid syndrome inadequately controlled with OCT-LAR, who had been included into a phase III open-label study [90]. There have been several case reports of an effective off-label PAS treatment of hypoglycemia in patients with insulinoma [91][92][93][94], nesidioblastosis [95], and non-islet cell tumors [92]. To date, PAS efficacy has been demonstrated in some patients with medullary thyroid cancer [96], and a limited clinical benefit of PAS was shown in the treatment of advanced hepatocellular carcinoma [97].…”

Section: Neoplasmsmentioning

confidence: 99%

Pasireotide—a novel somatostatin receptor ligand after 20 years of use

Bolanowski

Kałużny

Witek

et al. 2022

Rev Endocr Metab Disord

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Pasireotide, a novel multireceptor-targeted somatostatin receptor ligand (SRL) is characterized by a higher affinity to somatostatin receptor type 5 than type 2, unlike first-generation SRLs. Because of the broader binding profile, pasireotide has been suggested to have a greater clinical efficacy in acromegaly than first-generation SRLs and to be efficacious in Cushing’s disease. The consequence of this binding profile is the increased blood glucose level in some patients. This results from the inhibition of both insulin secretion and the incretin effect and only a modest suppression of glucagon. A monthly intramuscular formulation of long-acting release pasireotide has been approved for both acromegaly and Cushing’s disease treatment. This review presents data on the efficacy and safety of pasireotide treatment mostly in patients with acromegaly and Cushing’s disease. Moreover, other possible therapeutic applications of pasireotide are mentioned.

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Section: Neoplasmsmentioning

confidence: 99%

Pasireotide—a novel somatostatin receptor ligand after 20 years of use

Bolanowski

Kałużny

Witek

et al. 2022

Rev Endocr Metab Disord

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“…4 There are few case reports of its use in insulinomas refractory to standard medical therapy. 1,3,5 We report a case of endogenous hyperinsulinemic hypoglycemia refractory to guideline-recommended medical therapy, in whom pasireotide resulted in more effective control of hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of insulinomas is estimated to be 1-4 cases/million/ year. 1 The typical clinical presentation is fasting hypoglycemia, but cases having exclusive postprandial episodes have also been reported. 2 The diagnosis of insulinomas is made by establishing inappropriately high insulin levels during episodes of hypoglycemia with a negative drug screen for insulin secretogogues.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of insulinomas is estimated to be 1–4 cases/million/year. 1 The typical clinical presentation is fasting hypoglycemia, but cases having exclusive postprandial episodes have also been reported. 2 …”

Section: Introductionmentioning

confidence: 99%

“… 4 There are few case reports of its use in insulinomas refractory to standard medical therapy. 1 , 3 , 5 …”

Section: Introductionmentioning

confidence: 99%

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Pasireotide use for the treatment of endogenous hyperinsulinemic hypoglycemia refractory to conventional medical therapy: A case report and review of the literature

Husni

Khan

Alghaieb

et al. 2022

Clinical Case Reports

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Insulinomas are rare neuroendocrine pancreatic tumors that can be associated with severe episodes of hypoglycemia, leading to significant morbidity and mortality. These tumors are often difficult to localize, and hypoglycemia control can be challenging since glucose levels can be resistant to conventional therapies. Pasireotide is a novel somatostatin analog with a high affinity to multiple somatostatin receptors. It has up to 40 times higher affinity for somatostatin receptor subtype 5 in comparison with octreotide, leading to a higher inhibition of insulin release from beta cells. There are few case reports regarding the use of pasireotide in refractory hyperinsulinemic hypoglycemia. We describe a challenging case of endogenous hyperinsulinemic hypoglycemia refractory to standard medical treatment, in which pasireotide was used. In this case, imaging studies and calcium stimulation testing failed to localize an insulin‐secreting tumor in an 83‐year‐old woman. Glucose levels remained low despite treatment with diazoxide, verapamil, and octreotide, necessitating the use of IV dextrose solutions. After starting subcutaneous (SC) pasireotide 0.9 mg twice a day, there was a significant improvement in the frequency and severity of hypoglycemic events, allowing the patient to be discharged from the hospital without needing IV glucose support.

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