Prolonged life-threatening hypoglycaemia following dose escalation of octreotide LAR in a patient with malignant polysecreting pancreatic neuroendocrine tumour

Endocrinology, Diabetes & Metabolism Case Reports

article

Sally K Abell¹  Jessie Teng¹  Anthony Dowling¹  Michael S Hofman²  Richard J MacIsaac¹  Nirupa Sachithanandan¹ 

[1] St Vincent’s Hospital;Department of Medicine, University of Melbourne;Molecular Imaging, Centre for Cancer Imaging, Peter MacCallum Cancer Centre

关键词: Adult;    Male;    Asian - Vietnamese;    Australia;    Pancreas;    Endocrine Cancers;    Insulin;    Gastrin;    Neuroendocrine tumour;    Hypoglycaemia;    Bony metastases;    Hepatic metastases;    Peptic ulcer;    Hypoglycaemia;    Hyponatraemia;    Coma;    Gastrin;    Supervised 72-hour fast;    CT;    SPECT scan;    Glucose (blood);    Proinsulin;    Radiotherapy;    Radionuclide therapy;    Somatostatin analogues;    Octreotide;    Diazoxide;    Dexamethasone;    Glucocorticoids;    Hydrochlorothiazide;    Glucagon;    Unusual effects of medical treatment;    January;    2015;   

DOI  :  10.1530/EDM-14-0097

学科分类：血液学

来源: Bioscientifica Ltd.

【 摘 要 】

This paper details the case of a 77-year-old male with refractory hypoglycaemia due to inoperable metastatic pancreaticneuroendocrine tumour (pNET) co-secreting insulin and gastrin. Multiple medical therapies were trialled with limitedsuccess, and we describe the complications experienced by our patient. Somatostatin analogues can amelioratehypoglycaemia and may have tumour-stabilising effects; however, in our case resulted in paradoxical worsening ofhypoglycaemia. This rendered our patient hospital dependent for glycaemic support including continuous dextrose infusion.Although this is a reported adverse effect with initiation of therapy, we describe successful initiation of short-actingoctreotide as an inpatient followed by commencement of long-acting octreotide. Hypoglycaemic collapse occurred onlyafter dose titration of long-acting octreotide. We outline the pitfalls of somatostatin analogue therapy and the mechanismsthat may contribute to worsening hypoglycaemia. This rare side effect cannot be reliably predicted, necessitating closesupervision and glucose monitoring during therapy. Our patient achieved disease stabilisation and gradual resolutionof hypoglycaemia with peptide receptor radionuclide therapy (PRRT), an emerging therapeutic option for metastaticneuroendocrine tumours with high efficacy and low toxicity. We present a brief but comprehensive discussion ofcurrently available and novel therapies for insulin secreting pNETs.

【 授权许可】

CC BY-NC-ND