EUH Hunt Conference: What is the treatment for insulinomas?

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).
  • Surgery:
    • 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&sectionid=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).

Treatment overview:

  • 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)

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