From the Guidelines
Neuroendocrine tumors (NETs) of islet cells beyond insulinoma include gastrinoma, glucagonoma, VIPoma, somatostatinoma, pancreatic polypeptidoma (PPoma), and vasoactive intestinal polypeptide tumor (VIPoma), each requiring specific management approaches based on their hormone secretion and clinical presentation. The notable types of NETs of islet cells apart from insulinoma are:
- Gastrinoma
- Glucagonoma
- VIPoma
- Somatostatinoma
- Pancreatic polypeptidoma (PPoma)
- Vasoactive intestinal polypeptide tumor (VIPoma) These tumors are managed based on their hormone secretion and clinical presentation, with treatment options including surgical resection, somatostatin analogs, targeted therapies, peptide receptor radionuclide therapy (PRRT), and chemotherapy regimens, as guided by tumor functionality, grade, stage, and patient-specific factors 1. An octreotide scan will be of no benefit in insulinoma, as only about 50% of insulinomas express somatostatin receptors (SSTR2), making it less sensitive for diagnosing this type of tumor 1. Management approaches for these NETs include:
- Gastrinomas: high-dose proton pump inhibitors and surgical resection
- Glucagonomas: surgical resection and somatostatin analogs
- VIPomas: aggressive fluid and electrolyte replacement, somatostatin analogs, and surgical resection
- Somatostatinomas: surgical resection with adjunctive somatostatin analogs For metastatic disease, treatment options include somatostatin analogs, targeted therapies, PRRT, and chemotherapy regimens, based on tumor grade and patient-specific factors 1.
From the Research
Neuroendocrine Tumors of Islet Cells
- The following are 6 neuroendocrine tumors of islet cells apart from insulinoma:
Octreotide Scan Benefit
- An octreotide scan will be of no benefit in non-functioning neuroendocrine tumors, as they do not express somatostatin receptors 5.
- However, it is beneficial for tumors that express somatostatin receptors, such as somatostatinoma 2.
- The use of octreotide scans is part of the diagnostic approach for neuroendocrine tumors, along with other imaging methods like ultrasound, endoscopic ultrasound, and computer tomography 2, 3.