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

Endocrinology, Diabetes & Metabolism Case Reports
Sally K AbellNirupa Sachithanandan

Abstract

This paper details the case of a 77-year-old male with refractory hypoglycaemia due to inoperable metastatic pancreatic neuroendocrine tumour (pNET) co-secreting insulin and gastrin. Multiple medical therapies were trialled with limited success, and we describe the complications experienced by our patient. Somatostatin analogues can ameliorate hypoglycaemia and may have tumour-stabilising effects; however, in our case resulted in paradoxical worsening of hypoglycaemia. 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-acting octreotide as an inpatient followed by commencement of long-acting octreotide. Hypoglycaemic collapse occurred only after dose titration of long-acting octreotide. We outline the pitfalls of somatostatin analogue therapy and the mechanisms that may contribute to worsening hypoglycaemia. This rare side effect cannot be reliably predicted, necessitating close supervision and glucose monitoring during therapy. Our patient achieved disease stabilisation and gradual resolution of hypoglycaemia with peptide receptor radionuclide therapy (PRRT), ...Continue Reading

References

May 4, 2001·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·T AparicioP Rougier
Apr 3, 2002·European Journal of Nuclear Medicine and Molecular Imaging·Aseem BhatnagarRavi Kashyap
Jun 21, 2008·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·James C YaoDouglas B Evans
Feb 19, 2010·European Journal of Endocrinology·Gregory S Y OngP Gerry Fegan
Feb 11, 2011·The New England Journal of Medicine·Eric RaymondPhilippe Ruszniewski
Feb 11, 2011·The New England Journal of Medicine·James C YaoUNKNOWN RAD001 in Advanced Neuroendocrine Tumors, Third Trial (RADIANT-3) Study Group
Sep 16, 2011·The Journal of Clinical Endocrinology and Metabolism·E van SchaikW W de Herder
Feb 9, 2013·European Journal of Endocrinology·Valérie BernardUNKNOWN French Group of Endocrine Tumors

❮ Previous
Next ❯

Citations

Mar 30, 2017·Neuroendocrinology·Marianne PavelUNKNOWN Antibes Consensus Conference participants
Apr 13, 2017·Endocrine-related Cancer·David A Pattison, Rodney J Hicks
Aug 15, 2017·Clinical Pediatric Endocrinology : Case Reports and Clinical Investigations : Official Journal of the Japanese Society for Pediatric Endocrinology·Tohru YorifujiUNKNOWN (on behalf of The Japanese Society for Pediatric Endocrinology and The Japanese Society of Pediatric Surgeons)

❮ Previous
Next ❯

Methods Mentioned

BETA
surgical resection

Related Concepts

Related Feeds

Carcinoma, Islet Cell (Keystone)

Islet Cell Carcinoma or Pancreatic Neuroendocrine Tumours arise in the hormone producing cells of the pancreas. These tumors can be either malignant or benign. Discover the latest research on islet cell carcinoma in this feed.

Carcinoma, Islet Cell

Islet Cell Carcinoma or Pancreatic Neuroendocrine Tumours arises in the hormone producing cells of the pancreas. These tumors can be either malignant or benign. Discover the latest research on Islet Cell Carcinoma here.

Adenoma, Islet Cell

Islet Cell Adenoma arises in the islet cells, which are insulin producing cells of the pancreas. These tumors can be either malignant or benign. Discover the latest research on Islet Cell Adenoma here.