From the Guidelines
Insulinoma treatment primarily involves surgical removal of the tumor, which is the definitive and curative approach for most patients. Surgery options include enucleation for small, benign tumors or partial pancreatectomy for larger or multiple tumors 1. Before surgery, medical management focuses on controlling hypoglycemia through frequent small meals, intravenous glucose if needed, and medications like diazoxide to inhibit insulin release 1.
Key Considerations
- For patients who cannot undergo surgery or have metastatic disease, additional options include everolimus (10 mg daily) 1, or chemotherapy regimens.
- Somatostatin analogs like octreotide should be used with caution in patients with insulinoma because they can also suppress counterregulatory hormones, such as growth hormone, glucagon, and catecholamines, and can result in fatal complications 1.
- The treatment approach depends on tumor size, location, malignancy status, and patient factors.
Medical Management
- Diazoxide is of value in metastatic insulinoma, as it inhibits the secretion of insulin by tumour cells 1.
- Continuous glucose monitoring may be helpful for managing symptoms.
- Surgical intervention works by removing the source of excess insulin production, while medical therapies either reduce insulin secretion or counteract its effects to maintain normal blood glucose levels.
From the FDA Drug Label
Diazoxide Oral Suspension is indicated for the management of hypoglycemia due to hyperinsulinism associated with the following conditions: Adults: Inoperable islet cell adenoma or carcinoma, or extrapancreatic malignancy. Diazoxide Oral Suspension may be used preoperatively as a temporary measure, and postoperatively, if hypoglycemia persists.
Insulinoma treatment with diazoxide (PO) may be considered when:
- The tumor is inoperable
- Other specific medical therapy or surgical management has been unsuccessful or is not feasible Diazoxide can be used preoperatively as a temporary measure, and postoperatively, if hypoglycemia persists 2
From the Research
Treatment Options for Insulinoma
- Surgery is the ideal treatment for insulinoma, with a high success rate for benign tumors 3, 4, 5
- Systemic therapy, such as diazoxide or somatostatin analogues, may be required to prevent severe preoperative hypoglycemia or in cases where surgery is contraindicated or delayed 3
- Somatostatin analogues, such as octreotide and lanreotide, may be an effective alternative to diazoxide in patients with insulinoma refractory and/or intolerant to diazoxide 3
Surgical Management
- Simple excision, enucleation, partial or distal pancreatectomy, or pancreaticoduodenectomy may be performed depending on the location and size of the tumor 4, 5
- Parenchyma-sparing pancreatectomies, including enucleation and caudal pancreatectomy, may be proposed as the first-line surgical strategy to preserve pancreatic function 5
- Accurate preoperative localization of the tumor using computed tomography, magnetic resonance imaging, and endoscopic ultrasonography is crucial for successful surgical management 5
Medical Management
- Somatostatin receptor ligands, such as octreotide and lanreotide, may be used to control hypoglycemia in patients with insulinoma 6
- Peptide receptor radionuclide therapy (PRRT) may be an effective treatment option for patients with metastatic insulinoma, providing long-lasting symptom control and reduction of antihypoglycemic medications 7
- Everolimus, sunitinib, and cytotoxic chemotherapy may also be valuable options for the treatment of aggressive malignant insulinoma 6