Metastatic
insulinomas may sometimes present with recurrent life-threatening
hypoglycemia episodes. Such patients usually fail to respond to various therapeutic agents which causes constant
dextrose infusion requirement. Herein, we present a resistant case of inoperable malignant
insulinoma who was treated with many therapeutic agents and interventions including
somatostatin analogues,
Yttrium-90 radioembolization,
everolimus,
radiotherapy, and chemoembolization. Close
blood sugar monitorization during these
therapies showed the most favourable response with
everolimus.
Everolimus treatment resulted in rapid improvement of
hypoglycemia episodes, letting us discontinue
dextrose infusion and discharge the patient. However, experience with
everolimus in such patients is still limited, and more precise data can be obtained with the increasing use of this agent for neuroendocrine tumours.