Short‐ and long‐term somatostatin analogue treatment in patients with hypoglycaemia related to endogenous hyperinsulinism

Abstract

Summary Background The long‐term efficacy of somatostatin analogues on insulinomas has not been studied. Design A prospective study to evaluate the response of octreotide in 21 patients with hypoglycaemia related to endogenous hyperinsulinism who were not treated by surgery. Results Reasons for not undergoing surgery were: refusal (n = 3), old age with multiple diseases (n = 5), unlocalized insulinomas (n = 2), malignant unresectable insulinomas (n = 5), multiple insulinomas (n = 3) and diffuse β‐cell disease (n = 3). Hypoglycaemia was responsive to octreotide in 14 of the 21 patients. A short 100‐µg octreotide test correctly predicted the efficacy of treatment in six patients with benign insulinomas. Octreoscan scintigraphy was positive in 6 of the 16 patients of whom three were responsive and three unresponsive to octreotide. Octreoscan scintigraphy was negative in 10 of the 16 patients, eight of whom were responsive to octreotide. Subcutaneous octreotide treatment was prolonged for > 6 months (7–144 months, 67 ± 47 months) in 11 responsive patients. No tachyphylaxis was observed. However, the octreotide dose had to be increased in two patients after 3 and 18 months, respectively. Only one patient suffered from symptomatic biliary lithiasis after 3 years of treatment. Conclusion Long‐term octreotide treatment can be used to control hypoglycaemia in patients with endogenous hyperinsulinism who are not eligible for surgery; octreotide efficacy on hypoglycaemia could be predicted by a short 100 µg‐octreotide test in patients with benign insulinomas, but was not correctly predicted by Octreoscan scintigraphy.

Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment

“…4 The clinical features, associated malignancies, diagnostic studies, and treatment options of paraneoplastic endocrine syndromes are listed in Table 1. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Syndrome of InapproprIate antIdIuretIc Hormone SecretIon The syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is characterized by hypo-osmotic, euvolemic hyponatremia, affects 1% to 2% of all patients with cancer. Small cell lung cancer accounts for most of these cases, with approximately 10% to 45% of all patients with small cell lung cancer developing SIADH.…”

Diagnosis and Treatment of Insulinomas in the Adults

“…A short 100 µg octreotide test, not Octreoscan uptake, was predictive of the long-term efficacy of octreotide treatment on hypoglycaemia. This could be explained by the differing affinities of Octreoscan and octreotide for sst2 receptor (Reubi et al 2000;Vezzosi et al 2008). Worsening of hypoglycaemia after administration of somatostatin analogues has been reported (Healy et al 2007).…”

“…Such phenomenon could be explained by glucagon suppression by somatostatin analogues. It has not been observed in all series (Vezzosi et al 2008). Glucocorticoids may be used to normalize plasma glucose levels in insulinoma patients (Novotny et al 2005).…”

“…Diuretics may be added to treatment with diazoxide in order to control oedemas, and thiazides are known to potentiate the anti-hypoglycemic effects of diazoxide, but may induce electrolytic disorders or cause worsening of hypokalemia. Somatostatin analogues can achieve normalization of plasma glucose levels in 50-60% of the patients (Vezzosi et al 2008). There are only few adverse effects, mostly digestive intolerance with diarrhoea and steatorrhea.…”

GEP-NETs update: Functional localisation and scintigraphy in neuroendocrine tumours of the gastrointestinal tract and pancreas (GEP-NETs)

“…However, as opposed to benign insulinomas, malignant insulinomas often lack GLP1R (60). Conversely, malignant insulinomas often do express sst 2 , which can be targeted using SRS (24,60,61,62,63,64,65,66). In various studies, GLP1R scintigraphy using 111 In-DOTAexendin-4 successfully detected benign insulinomas (60,67,68,69,70).…”