Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours
Objective: Somatostatin analogues (SSA) are used in the management of patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEP-NET) to control hormone secretion and tumour growth. SSA can paradoxically worsen or unmask hypoglycaemia in patients with insulinoma by inhibiting counte...
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Bioscientifica
2025-07-01
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| Series: | Endocrine Oncology |
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| Online Access: | https://eo.bioscientifica.com/view/journals/eo/5/1/EO-25-0005.xml |
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| author | Isuru Gamage Emma Boehm Gaurav Ghosh Grace Kong Michael Michael HuiLi Wong Oliver Piercey Nirupa Sachithanandan |
| author_facet | Isuru Gamage Emma Boehm Gaurav Ghosh Grace Kong Michael Michael HuiLi Wong Oliver Piercey Nirupa Sachithanandan |
| author_sort | Isuru Gamage |
| collection | DOAJ |
| description | Objective: Somatostatin analogues (SSA) are used in the management of patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEP-NET) to control hormone secretion and tumour growth. SSA can paradoxically worsen or unmask hypoglycaemia in patients with insulinoma by inhibiting counter-regulatory hormones such as glucagon and growth hormone. Design and methods: We present two cases of SSA use in patients with initially presumed non-functioning GEP-NET unmasking insulinoma. We review the use of SSA in GEP-NET and the management of refractory hypoglycaemia in metastatic insulinoma. Results: A 62-year-old female with metastatic grade 2 GEP-NET was commenced on monthly lanreotide 10 weeks after diagnosis. She presented 1 week following the second dose with refractory hypoglycaemia and inappropriate hyperinsulinism, requiring inpatient dextrose infusion. SSA was stopped; however, she remained dextrose dependent despite the addition of diazoxide and dexamethasone. Peptide receptor radionuclide therapy (PRRT) with 177 Lu-DOTA-Octreotate was given, resulting in resolution of hypoglycaemia after two cycles. The second case is a 57-year-old female with metastatic grade 2 GEP-NET. Four months post commencement of lanreotide, she presented with radiological disease progression and symptomatic hypoglycaemia. A 72 h fast confirmed hyperinsulinaemic hypoglycaemia. SSA was stopped. A trial of diazoxide was not tolerated, and a prednisolone trial was ineffective. The patient underwent inpatient PRRT with euglycaemia achieved shortly afterwards. Conclusions: SSA can unmask hypoglycaemia secondary to insulinoma. Detection of new-onset hypoglycaemia requires careful clinical vigilance when commencing SSA in patients with GEP-NET initially presumed to be non-functional. Hypoglycaemia from metastatic insulinoma requires multidisciplinary management incorporating nutritional, medical and oncologic therapy. PRRT can be effective in managing refractory hypoglycaemia. |
| format | Article |
| id | doaj-art-dbe5394522ab4019bfcd774b74d013db |
| institution | DOAJ |
| issn | 2634-4793 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrine Oncology |
| spelling | doaj-art-dbe5394522ab4019bfcd774b74d013db2025-08-20T03:15:28ZengBioscientificaEndocrine Oncology2634-47932025-07-015110.1530/EO-25-00051Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumoursIsuru Gamage0Emma Boehm1Gaurav Ghosh2Grace Kong3Michael Michael4HuiLi Wong5Oliver Piercey6Nirupa Sachithanandan7Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, AustraliaENETS Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, AustraliaENETS Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, AustraliaENETS Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, AustraliaENETS Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, AustraliaENETS Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, AustraliaENETS Centre of Excellence, Peter MacCallum Cancer Centre, Melbourne, AustraliaDepartment of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, AustraliaObjective: Somatostatin analogues (SSA) are used in the management of patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEP-NET) to control hormone secretion and tumour growth. SSA can paradoxically worsen or unmask hypoglycaemia in patients with insulinoma by inhibiting counter-regulatory hormones such as glucagon and growth hormone. Design and methods: We present two cases of SSA use in patients with initially presumed non-functioning GEP-NET unmasking insulinoma. We review the use of SSA in GEP-NET and the management of refractory hypoglycaemia in metastatic insulinoma. Results: A 62-year-old female with metastatic grade 2 GEP-NET was commenced on monthly lanreotide 10 weeks after diagnosis. She presented 1 week following the second dose with refractory hypoglycaemia and inappropriate hyperinsulinism, requiring inpatient dextrose infusion. SSA was stopped; however, she remained dextrose dependent despite the addition of diazoxide and dexamethasone. Peptide receptor radionuclide therapy (PRRT) with 177 Lu-DOTA-Octreotate was given, resulting in resolution of hypoglycaemia after two cycles. The second case is a 57-year-old female with metastatic grade 2 GEP-NET. Four months post commencement of lanreotide, she presented with radiological disease progression and symptomatic hypoglycaemia. A 72 h fast confirmed hyperinsulinaemic hypoglycaemia. SSA was stopped. A trial of diazoxide was not tolerated, and a prednisolone trial was ineffective. The patient underwent inpatient PRRT with euglycaemia achieved shortly afterwards. Conclusions: SSA can unmask hypoglycaemia secondary to insulinoma. Detection of new-onset hypoglycaemia requires careful clinical vigilance when commencing SSA in patients with GEP-NET initially presumed to be non-functional. Hypoglycaemia from metastatic insulinoma requires multidisciplinary management incorporating nutritional, medical and oncologic therapy. PRRT can be effective in managing refractory hypoglycaemia.https://eo.bioscientifica.com/view/journals/eo/5/1/EO-25-0005.xmlinsulinomaneuroendocrine neoplasmssomatostatin analoguepeptide receptor radionuclide therapyradionuclide therapyneuroendocrine tumourhypoglycaemiametastatic insulinomametastatic neuroendocrine tumour |
| spellingShingle | Isuru Gamage Emma Boehm Gaurav Ghosh Grace Kong Michael Michael HuiLi Wong Oliver Piercey Nirupa Sachithanandan Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours Endocrine Oncology insulinoma neuroendocrine neoplasms somatostatin analogue peptide receptor radionuclide therapy radionuclide therapy neuroendocrine tumour hypoglycaemia metastatic insulinoma metastatic neuroendocrine tumour |
| title | Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours |
| title_full | Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours |
| title_fullStr | Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours |
| title_full_unstemmed | Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours |
| title_short | Unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours |
| title_sort | unmasking insulinoma following commencement of somatostatin analogues in malignant neuroendocrine tumours |
| topic | insulinoma neuroendocrine neoplasms somatostatin analogue peptide receptor radionuclide therapy radionuclide therapy neuroendocrine tumour hypoglycaemia metastatic insulinoma metastatic neuroendocrine tumour |
| url | https://eo.bioscientifica.com/view/journals/eo/5/1/EO-25-0005.xml |
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