The Bottom Line:
- Diet: small frequent meals throughout the day and in them idle of the night to prevent hypoglycemia (DynaMed Plus, 2017).
- Medications: Diazoxide is administered to suppress insulin release. For incurable islet cell carcinomas, steptozocin is the best chemotherapeutic agent. Approximately 60% of patients live up to 2 additional years. Toxicity is considerable; steptozocin is not recommended as a routine adjunct to surgical therapy (Doherty, 2014).
- For benign insulinoma surgery is treatment of choice, with a 98% cure rate reported (DyanMed Plus, 2017). Surgical options include: resection of pancreatic neuroendocrine tumors, enucleation if a lesion can be found, segmental resection, distal pancreatectomy, pancreaticoduodenectopy. Laparoscopic surgery may result in shorter hospital stay.
- For metastatic disease: resection of tumor and metastasis, lymphadenectomy, radiofrequency ablation.
References: Doherty GM. Pancreas. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 14e New York, NY: McGraw-Hill; 2014. http://accesssurgery.mhmedical.com/content.aspx?bookid=1202§ionid=71521584. Accessed November 08, 2017.
DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 115754, Insulinoma; [updated 2017 May 22, cited 2017 Nov 09]; [about 8 screens]. Emory login required.
Summary: Insulinomas have been reported in all age groups. Approximately 75% are solitary and benign. About 10% are malignant, and metastases are usually evident at the time of diagnosis. The remaining 15% are manifestations of multifocal pancreatic disease, either adenomatosis, nesidioblastosis, or islet cell hyperplasia (Doherty, 2014).
- For locoregional disease
- manage hypoglycemia using diet, diazoxide, octreotide (but may worsen hypoglycemia in some patients), lanreotide (improves progression-free survival but not overall survival). Other drugs have been used to help control blood sugar.
- tumor removal: tumor enucleation, subtotal or distal pancreatectomy, pancreaticoduodenectomy
- For metastatic disease
- manage hypoglycemia with diet and medication
- other treatment options include: resection of primary lesions and metastases, ablative therapy (tumor destruction), arterial embolization or chemoembolization, systemic chemotherapy, radiation therapy is under investigation.
(DynaMed Plus, 2017)