From the Guidelines
Surgical removal of the tumor is the primary treatment for insulinoma, and before surgery, patients should manage symptoms by stabilizing glucose levels with diet and/or diazoxide, as recommended by the panel 1. The management of insulinoma involves a combination of medical and surgical approaches.
- Medical management includes stabilizing glucose levels with diet and/or diazoxide, as this can help control hypoglycemic symptoms.
- Octreotide or lanreotide should be used with caution in patients with insulinoma, as they can suppress counterregulatory hormones and worsen hypoglycemia 1.
- For acute hypoglycemic episodes, immediate treatment with oral glucose or intravenous dextrose is necessary. Some key points to consider in the management of insulinoma include:
- The use of somatostatin analogues, such as octreotide or lanreotide, should be carefully considered, as they may not be effective in all patients and can have adverse effects 1.
- The diagnosis of insulinoma is typically made through biochemical testing, including fasting hypoglycemia with inappropriately high insulin levels, and localization studies, such as CT, MRI, or endoscopic ultrasound 1.
- Surgical removal of the tumor is the primary treatment for insulinoma, and laparoscopic or open surgical enucleation is performed for benign tumors, while malignant insulinomas may require partial pancreatectomy.
- Most insulinomas (90%) are benign, and surgical removal is curative in most cases 1.
From the Research
Definition and Diagnosis of Insulinoma
- Insulinoma is a rare tumor of the Langerhans islets of the pancreas that produces insulin and causes severe hypoglycemia with neuroglycopenic symptoms 2.
- The diagnosis is based on the presence of Whipple's triad and the result of a fasting test 2, 3.
- Insulinomas are most commonly benign, well-differentiated neuroendocrine tumors (NETs), whereas malignant neoplasms account for approximately 5-10% of all cases 4.
Treatment Options for Insulinoma
- Surgery is the ideal treatment of insulinoma, and curative surgical excision remains the treatment of choice for single solitary insulinomas 5, 2, 3.
- Systemic therapy may be required to prevent severe preoperative hypoglycemia, when surgery is contraindicated, delayed, or refused, and in case of unresectable metastatic disease 5.
- Somatostatin analogues (octreotide and lanreotide) may be an alternative option for patients with insulinoma refractory and/or intolerant to diazoxide or with a high risk of fluid retention 5, 6.
- Supportive measures and somatostatin receptor ligands can be used to control hypoglycemia 3.
Management of Insulinoma
- Management includes conservative treatment with drugs targeting insulin-induced hypoglycemia, non-operative invasive procedures, as well as curative open or laparoscopic tumor resection 4.
- For aggressive malignant cases, debulking procedures, somatostatin receptor ligands, peptide receptor radionuclide therapy, everolimus, sunitinib, and cytotoxic chemotherapy can be valuable options 3.
- The centralization of patients is recommended due to the low incidence of the condition 2.