Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Insulinoma Medication

  • Author: Zonera Ashraf Ali, MBBS; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
 
Updated: Feb 21, 2016
 

Medication Summary

Diazoxide is the drug of choice because it inhibits insulin release from the tumor. Adverse effects must be treated with hydrochlorothiazide. In patients not responsive to or intolerant of diazoxide (10%), somatostatin may be indicated to prevent hypoglycemia.

Next

Hyperglycemic agents

Class Summary

Inhibit insulin release from the tumor.

Diazoxide (Proglycem, Hyperstat)

 

Produces an increase in blood glucose within 1 h by inhibition of insulin release from the insulinoma.

Previous
Next

Diuretics

Class Summary

Used to counteract edema and hyperkalemia secondary to diazoxide and to potentiate its hyperglycemic effect.

Hydrochlorothiazide (Microzide, HydroDIURIL, Esidrix)

 

Inhibits reabsorption of sodium in distal tubules, causing increased excretion of sodium and water as well as potassium and hydrogen ions.

Previous
Next

Somatostatin analogs

Class Summary

May control symptoms by suppressing secretion of gastroenteropancreatic peptides including insulin. High-dose treatment also may lead to additional antiproliferative effects. However, long-term application of somatostatin may down-regulate receptor expression levels, resulting in decreased efficiency despite increasing doses. Both short- and long-acting depot preparations are available.

Octreotide acetate (Sandostatin)

 

Acts similarly to the natural hormone somatostatin and can suppress secretion of gastroenteropancreatic peptides including insulin.

Previous
Next

Antineoplastic Agents

Class Summary

These agents inhibit cell growth and proliferation.

Streptozocin (Zanosar)

 

Used in fasting hypoglycemia caused by tumor. Has high affinity for neuroendocrine cells, inhibits cell proliferation, and is cytolytic. Interferes with normal function of DNA by alkylation and protein modification.

Previous
Next

Antineoplastic, Mtor Kinase Inhibitor

Previous
 
 
Contributor Information and Disclosures
Author

Zonera Ashraf Ali, MBBS Consulting Staff, Main Line Oncology Hematology Associates, Lankenau Cancer Center

Zonera Ashraf Ali, MBBS is a member of the following medical societies: American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Pradyumna D Phatak, MBBS, MD Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute

Pradyumna D Phatak, MBBS, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Received honoraria from Novartis for speaking and teaching.

Acknowledgements

Klaus Radebold, MD, PhD Former Research Associate, Department of Surgery, Yale University School of Medicine

Disclosure: Nothing to disclose.

References
  1. Kirkeby H, Vilmann P, Burcharth F. Insulinoma diagnosed by endoscopic ultrasonography-guided biopsy. J Laparoendosc Adv Surg Tech A. 1999 Jun. 9(3):295-8. [Medline].

  2. Proye C, Malvaux P, Pattou F, et al. Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphy. Surgery. 1998 Dec. 124(6):1134-43; discussion 1143-4. [Medline].

  3. McLean A. Endoscopic ultrasound in the detection of pancreatic islet cell tumours. Cancer Imaging. 2004 Mar 29. 4(2):84-91. [Medline].

  4. Fernandez-Cruz L, Blanco L, Cosa R, Rendon H. Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors?. World J Surg. 2008 May. 32(5):904-17. [Medline].

  5. Phan GQ, Yeo CJ, Hruban RH, et al. Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: review of 125 patients. J Gastrointest Surg. 1998 Sep-Oct. 2(5):472-82. [Medline].

  6. Mathur A, Gorden P, Libutti SK. Insulinoma. Surg Clin North Am. 2009 Oct. 89(5):1105-21. [Medline].

  7. Zhan HX, Cong L, Zhao YP, Zhang TP, Chen G, Zhou L, et al. Activated mTOR/P70S6K signaling pathway is involved in insulinoma tumorigenesis. J Surg Oncol. 2012 Dec. 106(8):972-80. [Medline].

  8. Dadan J, Wojskowicz P, Wojskowicz A. Neuroendocrine tumors of the pancreas. Wiad Lek. 2008. 61(1-3):43-7. [Medline].

  9. Larijani B, Aghakhani S, Lor SS, Farzaneh Z, Pajouhi M, Bastanhagh MH. Insulinoma in Iran: a 20-year review. Ann Saudi Med. 2005 Nov-Dec. 25(6):477-80. [Medline].

  10. Dizon AM, Kowalyk S, Hoogwerf BJ. Neuroglycopenic and other symptoms in patients with insulinomas. Am J Med. 1999 Mar. 106(3):307-10. [Medline].

  11. Schmitt J, Boullu-Sanchis S, Moreau F, Drui S, Louis B, Chabrier G, et al. Association of malignant insulinoma and type 2 diabetes mellitus: a case report. Ann Endocrinol (Paris). 2008 Feb. 69(1):69-72. [Medline].

  12. Hrascan R, Pecina-Slaus N, Martic TN, Colic JF, Gall-Troselj K, Pavelic K. Analysis of selected genes in neuroendocrine tumours: insulinomas and phaeochromocytomas. J Neuroendocrinol. 2008 Aug. 20(8):1015-22. [Medline].

  13. Bhatti TR, Ganapathy K, Huppmann AR, Conlin L, Boodhansingh KE, MacMullen C, et al. Histologic and Molecular Profile of Pediatric Insulinomas: Evidence of a Paternal Parent-of-Origin Effect. J Clin Endocrinol Metab. 2016 Jan 12. 161 (3):jc20152914. [Medline].

  14. Waickus CM, de Bustros A, Shakil A. Recognizing factitious hypoglycemia in the family practice setting. J Am Board Fam Pract. 1999 Mar-Apr. 12(2):133-6. [Medline].

  15. Redmon JB, Nuttall FQ. Autoimmune hypoglycemia. Endocrinol Metab Clin North Am. 1999 Sep. 28(3):603-18, vii. [Medline].

  16. Eriguchi N, Aoyagi S, Hara M, et al. Nesidioblastosis with hyperinsulinemic hypoglycemia in adults: report of two cases. Surg Today. 1999. 29(4):361-3. [Medline].

  17. Starke A, Saddig C, Kirch B, Tschahargane C, Goretzki P. Islet hyperplasia in adults: challenge to preoperatively diagnose non-insulinoma pancreatogenic hypoglycemia syndrome. World J Surg. 2006 May. 30(5):670-9. [Medline].

  18. van Bon AC, Benhadi N, Endert E, Fliers E, Wiersinga WM. Evaluation of endocrine tests. D: the prolonged fasting test for insulinoma. Neth J Med. 2009 Jul-Aug. 67(7):274-8. [Medline].

  19. Guettier JM, Lungu A, Goodling A, Cochran C, Gorden P. The Role of Proinsulin and Insulin in the Diagnosis of Insulinoma: A Critical Evaluation of the Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2013 Sep 30. [Medline].

  20. Boukhman MP, Karam JM, Shaver J, et al. Localization of insulinomas. Arch Surg. 1999 Aug. 134(8):818-22; discussion 822-3. [Medline].

  21. Hashimoto LA, Walsh RM. Preoperative localization of insulinomas is not necessary. J Am Coll Surg. 1999 Oct. 189(4):368-73. [Medline].

  22. Liu Y, Song Q, Jin HT, Lin XZ, Chen KM. The value of multidetector-row CT in the preoperative detection of pancreatic insulinomas. Radiol Med. 2009 Sep 30. [Medline].

  23. Anaye A, Mathieu A, Closset J, Bali MA, Metens T, Matos C. Successful preoperative localization of a small pancreatic insulinoma by diffusion-weighted MRI. JOP. 2009 Sep 4. 10(5):528-31. [Medline].

  24. Wiesli P, Uthoff H, Perren A, et al. Are biochemical markers of neuroendocrine tumors coreleased with insulin following local calcium stimulation in patients with insulinomas?. Pancreas. 2011 Oct. 40(7):995-9. [Medline].

  25. Christ E, Wild D, Forrer F, Brändle M, Sahli R, Clerici T, et al. Glucagon-Like Peptide-1 Receptor Imaging for Localization of Insulinomas. J Clin Endocrinol Metab. 2009 Oct 9. [Medline].

  26. Luo Y, Pan Q, Shao Y, Yu M, Wu W, Xue H, et al. Glucagon-like Peptide-1 Receptor PET/CT with 68Ga-NOTA-exendin-4 for Detecting Localized Insulinoma: a Prospective Cohort Study. J Nucl Med. 2016 Jan 21. [Medline].

  27. Wild D, Christ E, Caplin ME, et al. Glucagon-like peptide-1 versus somatostatin receptor targeting reveals 2 distinct forms of malignant insulinomas. J Nucl Med. 2011 Jul. 52(7):1073-8. [Medline].

  28. Arnold R, Simon B, Wied M. Treatment of neuroendocrine GEP tumours with somatostatin analogues: a review. Digestion. 2000. 62 Suppl 1:84-91. [Medline].

  29. Keymeulen B, Bossuyt A, Peeters TL, Somers G. 111In-octreotide scintigraphy: a tool to select patients with endocrine pancreatic tumors for octreotide treatment?. Ann Nucl Med. 1995 Aug. 9(3):149-52. [Medline].

  30. Limmer S, Huppert PE, Juette V, Lenhart A, Welte M, Wietholtz H. Radiofrequency ablation of solitary pancreatic insulinoma in a patient with episodes of severe hypoglycemia. Eur J Gastroenterol Hepatol. 2009 Sep. 21(9):1097-101. [Medline].

  31. Bernard V, Lombard-Bohas C, Taquet MC, Caroli-Bosc FX, Ruszniewski P, Niccoli-Sire P, et al. Efficacy of Everolimus in Patients with Metastatic Insulinoma and Refractory Hypoglycemia. Eur J Endocrinol. 2013 Feb 7. [Medline].

  32. Lo CY, Lam KY, Fan ST. Surgical strategy for insulinomas in multiple endocrine neoplasia type I. Am J Surg. 1998 Apr. 175(4):305-7. [Medline].

  33. Fernandez Ranvier GG, Shouhed D, Inabnet WB 3rd. Minimally Invasive Techniques for Resection of Pancreatic Neuroendocrine Tumors. Surg Oncol Clin N Am. 2016 Jan. 25 (1):195-215. [Medline].

  34. Dexter SP, Martin IG, Leindler L, et al. Laparoscopic enucleation of a solitary pancreatic insulinoma. Surg Endosc. 1999 Apr. 13(4):406-8. [Medline].

  35. Grant CS. Surgical aspects of hyperinsulinemic hypoglycemia. Endocrinol Metab Clin North Am. 1999 Sep. 28(3):533-54. [Medline].

  36. Moscetti L, Saltarelli R, Giuliani R, et al. Intra-arterial liver chemotherapy and hormone therapy in malignant insulinoma: case report and review of the literature. Tumori. 2000 Nov-Dec. 86(6):475-9. [Medline].

  37. Smith MC, Liu J, Chen T, et al. OctreoTher: ongoing early clinical development of a somatostatin- receptor-targeted radionuclide antineoplastic therapy. Digestion. 2000. 62 Suppl 1:69-72. [Medline].

  38. Bourcier ME, Sherrod A, DiGuardo M, Vinik AI. Successful control of intractable hypoglycemia using rapamycin in an 86-year-old man with a pancreatic insulin-secreting islet cell tumor and metastases. J Clin Endocrinol Metab. 2009 Sep. 94(9):3157-62. [Medline].

  39. Gonzalez-Gonzalez A, Recio-Cordova JM. Liver metastases 9 years after removal of a malignant insulinoma which was initially considered benign. JOP. 2006. 7(2):226-9. [Full Text].

  40. Abboud B, Boujaoude J. Occult sporadic insulinoma: localization and surgical strategy. World J Gastroenterol. 2008 Feb 7. 14(5):657-65. [Medline].

  41. Ahlman H, Wangberg B, Jansson S, et al. Interventional treatment of gastrointestinal neuroendocrine tumours. Digestion. 2000. 62 Suppl 1:59-68. [Medline].

  42. Begu-Le Corroller A, Valero R, Moutardier V, Henry JF, Le Treut YP, Gueydan M. Aggressive multimodal therapy of sporadic malignant insulinoma can improve survival: A retrospective 35-year study of 12 patients. Diabetes Metab. 2008 Jun 13. [Medline].

  43. Yao JC, Evans DB. Pancreatic endocrine tumors. De Vita V, Lawrence T, Rosenberg S. De Vita, Hellman, and Rosenberg's Cancer. Principles and Practice of Oncology. 10th ed. Philadelphia, PA: Wolters Kluwer Health; 2015. 1205-17.

  44. Faggiano A, Mansueto G, Ferolla P, Milone F, del Basso de Caro ML, Lombardi G, et al. Diagnostic and prognostic implications of the World Health Organization classification of neuroendocrine tumors. J Endocrinol Invest. 2008 Mar. 31(3):216-23. [Medline].

  45. Rougier P, Mitry E. Chemotherapy in the treatment of neuroendocrine malignant tumors. Digestion. 2000. 62 Suppl 1:73-8. [Medline].

Previous
Next
 
CT scan image with oral and intravenous contrast in a patient with biochemical evidence of insulinoma. The 3-cm contrast-enhancing neoplasm (arrow) is seen in the tail of the pancreas (P) posterior to the stomach (S) (Yeo, 1993).
Endoscopic ultrasonography in a patient with an insulinoma. The hypoechoic neoplasm (arrows) is seen in the body of the pancreas anterior to the splenic vein (SV) (Rosch, 1992).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.