@article{3095507,
    title = "Malignant insulinoma in childhood",
    author = "Karachaliou, F.-H. and Vlachopapadopoulou, E. and Kaldrymidis, P. and Simatos, G. and Zacharea, M. and Spanidou-Karvouni, E. and Michalacos, S. and Voros, D.",
    journal = "Journal of Pediatric Endocrinology and Metabolism",
    year = "2006",
    volume = "19",
    number = "5",
    pages = "757-760",
    publisher = "Walter de Gruyter GmbH",
    doi = "10.1515/JPEM.2006.19.5.757",
    keywords = "C peptide;  glucagon;  insulin;  octreotide;  pentetreotide in 111, abdominal mass;  article;  case report;  childhood cancer;  female;  girl;  histopathology;  human;  hyperinsulinism;  hypoglycemia;  insulinoma;  liver metastasis;  lymph node metastasis;  nuclear magnetic resonance imaging;  pancreas resection;  postoperative period;  school child;  splenectomy;  symptom",
    abstract = "Pancreatic tumors constitute a rare surgical problem in infancy and childhood. Insulinomas are rare in all age groups with an estimated incidence of one per 250,000 person-years and even rarer in childhood. We report a 10 year-old girl with malignant insulinoma. The presenting symptom was hypoglycemic attacks. Laboratory investigation demonstrated that the hypoglycemia was due to hyperinsulinism. MRI of the abdomen revealed a mass at the tail of the pancreas. Distal pancreatectomy with splenectomy was performed. Histological examination showed malignant insulinoma with peripancreatic lymph node metastases. One month later abdominal MRI revealed the existence of multiple small metastatic foci in the liver, which were confirmed by In111 octreoscan. Treatment with octreotide was started and the disease is stable after 12 months of therapy. © Freund Publishing House Ltd., London.
Indications:1 patient with hyperinsulinism and hypoglycemia secondary to malignant insulinoma.
Patients:One 10-year-old female patient.
Results:At 6 and 12 months following Sandostatin treatment, hypersecretion-related symptoms and hypoglycemia seemed to be reasonably controlled. Sandostatin treatment was well tolerated without any side effects. After 12 months, the size and number of liver metastases on repeat MRI have not changed and no other metastatic lesion was observed.
TypeofStudy:This study described the outcome of Sandostatin treatment of hyperinsulinemic hypoglycemia in a patient with a malignant insulinoma accompanied with hepatic metastases. Case report.
DosageDuration:30 mg im monthly. Duration: intermittently for at least 12 months.
AdverseEffects:No adverse events occurred.
AuthorsConclusions:In our patient therapy with octreotide has so far controlled symptoms of hypoglycemia without any side effects.
FreeText:The patient presented with hypoglycemic symptoms, which had started 3-4 months earlier. She was asymptomatic after a 12-hour fasting and blood glucose level was 2.05 mmol/l with negative urinary ketones. Serum insulin was 12.67 μU/ml and insulin to glucose ratio of 0.4/l. Following glucagon administration, blood glucose increased from 1.77 mmol/l to 3.88 mmol/l after 10 minutes and to 4.38 mmol/l after 15 minutes. Hyperinsulinism was diagnosed. Computer tomography scan and magnetic resonance imaging (MRI) of the abdomen revealed a 1.7 centimeter mass at the tail of the pancreas which confirmed insulinoma. Pancreatectomy with splenectomy was performed, but she continued to experience mild hypoglycemia. Histological examination confirmed malignant insulinoma. After 1 month, hepatic metastases were detected on abdominal MRI. Sandostatin therapy was initiated."
}