From the Guidelines
The primary treatment for insulinoma is surgical removal of the tumor, specifically enucleation or partial pancreatectomy, which offers the best chance for complete cure. This approach is supported by the most recent and highest quality study, which emphasizes the importance of surgical management for insulinomas 1.
Key Considerations
- Surgery is preferred because insulinomas are typically benign (90-95% of cases), solitary, and small tumors that arise from pancreatic beta cells and cause hypoglycemia due to autonomous insulin secretion.
- Before surgery, patients should be stabilized with dietary modifications, including frequent small meals high in complex carbohydrates and avoiding fasting.
- Medical management may be used temporarily before surgery or for patients who cannot undergo surgery, with diazoxide being the most effective medication to inhibit insulin release 1.
- Other medications, such as octreotide, can be used with caution in patients with insulinoma, as they may worsen hypoglycemia 1.
- For malignant insulinomas, additional treatments may include chemotherapy, targeted therapies, or peptide receptor radionuclide therapy.
Surgical Approach
- Enucleation is the preferred surgical approach for exophytic or peripheral insulinomas, which can be performed laparoscopically for localized solitary tumors within the body and tail of the pancreas 1.
- Pancreatoduodenectomy may be considered for tumors in the head of the pancreas, while distal pancreatectomy with preservation of the spleen may be considered for smaller tumors not involving splenic vessels.
- Laparoscopic procedures are safe for patients with insulinomas and may be associated with shorter hospital stays 1.
Medical Management
- Diazoxide is the most effective medication to inhibit insulin release, starting at 50-100mg three times daily, up to 600-800mg/day 1.
- Octreotide can be used with caution in patients with insulinoma, at a dose of 100-500 micrograms subcutaneously 2-3 times daily, to inhibit insulin secretion 1.
- Glucocorticoids can help maintain blood glucose levels, but their use should be individualized based on patient needs.
Overall, the primary goal of treatment for insulinoma is to achieve complete surgical resection of the tumor, while minimizing morbidity and mortality, and improving quality of life. Surgical removal of the tumor is the most effective treatment approach, and medical management should be used as an adjunct to surgery, rather than as a replacement for it.
From the FDA Drug Label
Diazoxide Oral Suspension is indicated for the management of hypoglycemia due to hyperinsulinism associated with the following conditions: ... islet cell adenoma The primary treatment for Insuloma (insulinoma) is surgical management.
- Diazoxide may be used preoperatively as a temporary measure, and postoperatively, if hypoglycemia persists 2.
From the Research
Primary Treatment for Insuloma (Insulinoma)
The primary treatment for insulinoma is surgical resection of the tumor, which is considered the ideal treatment 3, 4, 5, 6.
Surgical Resection
- Surgical resection is the curative treatment with a high success rate 4
- In patients with solitary insulinomas, complete surgical removal of the tumor should be the primary goal 6
- Intraoperatively, maintenance of optimum glucose levels is of main concern because there may be severe hypoglycemia while handling the tumor 4
Alternative Treatments
- Medical therapy with diazoxide or somatostatin analogues may be necessary to treat hypoglycemic symptoms when surgery is contraindicated, delayed, or refused, or in cases of unresectable metastatic disease 3, 4, 5, 7
- Radiofrequency ablation (RFA) may be a suitable alternative treatment for patients who are not candidates for surgical therapy and in whom symptoms cannot be controlled by medical therapy 5
- Somatostatin analogues may be a safe, effective, and well-tolerated option in patients with insulinoma refractory and/or intolerant to diazoxide 3, 7