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Endoscopic ultrasound-guided ethanol ablation therapy for pancreatic insulinoma: an unusual strategy

Endocrinology, Diabetes & Metabolism Case Reports. 2017;1(1):1-5 DOI 10.1530/EDM-16-0145

 

Journal Homepage

Journal Title: Endocrinology, Diabetes & Metabolism Case Reports

ISSN: 2052-0573 (Online)

Publisher: Bioscientifica

LCC Subject Category: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: HTML

 

AUTHORS


Adriana de Sousa Lages (Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Center, Coimbra, Portugal)

Isabel Paiva (Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Center, Coimbra, Portugal)

Patrícia Oliveira (Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Center, Coimbra, Portugal)

Francisco Portela (Department of Gastroenterology, Coimbra Hospital and University Center, Coimbra, Portugal)

Francisco Carrilho (Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Center, Coimbra, Portugal)

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 9 weeks

 

Abstract | Full Text

Insulinomas are the most frequent cause of hyperinsulinaemic hypoglycaemia. Although surgical enucleation is the standard treatment, a few other options are available to high-risk patients who are elderly or present with co-morbidities. We present a case report of an 89-year-old female patient who was admitted to the emergency department due to recurrent hypoglycaemia, especially during fasting. Laboratory work-up raised the suspicion of hyperinsulinaemic hypoglycaemia, and abdominal CT scan revealed a 12 mm nodular hypervascular lesion of the pancreatic body suggestive of neuroendocrine tumour. The patient was not considered a suitable candidate for surgery, and medical therapy with diazoxide was poorly tolerated. Endoscopic ultrasound-guided ethanol ablation therapy was performed and a total of 0.6 mL of 95% ethanol was injected into the lesion by a transgastric approach; no complications were reported after the procedure. At 5 months of follow-up, no episodes of hypoglycaemia were reported, no diazoxide therapy was necessary, and revaluation abdominal CT scan revealed a pancreatic nodular lesion with a size involution of about half of its original volume. The patient is regularly followed-up at the endocrinology clinic and shows a significant improvement in her wellbeing and quality of life.