Transformation of metastatic nonfunctioning pancreatic neuroendocrine tumor into insulinoma—two case reports

• DOI: 10.21037/apc-22-1
• Publication Date: 2022-06-21T06:58:16Z
• Authors: Lawrence W. Wu; Syed M. Qasim Hus...; Jae W. Lee; Daniel H. Shu; Ralph H. Hruban; Daniel A. Laheru
• Keywords: Diazoxide; Pasireotide; Malignant Transformation

Background: Pancreatic neuroendocrine tumors (PanNETs) are rare neoplasms that characterized by hormonal symptoms. While most PanNETs nonfunctional, there have been a few reported cases of patients with previously nonfunctional developing significant symptoms, indicating transformation into functional PanNET. Case Description: We describe two metastatic non-functional PanNET insulinoma. The clinical presentations were for severe symptomatic hypoglycemia symptoms seizures and loss consciousness. diagnoses insulinoma confirmed inappropriately elevated insulin, pro-insulin, C-peptide levels drawn in the setting documented hypoglycemia, which improved dextrose supplementation. Given highly refractory nature disease, multimodal approach cytotoxic chemotherapy, metabolic suppression insulin secretion through somatostatin analogs diazoxide, glucose supplementation was utilized to treat Novel analogues higher binding affinity multiple receptor subtypes such as pasireotide demonstrated some effectiveness an adjunctive agent after transformation. Conclusions: This report highlights need clinicians be aware possibility PanNETs. Additionally, remains further research understand mechanism development additional therapies treatment