Endocrinology, Diabetes & Metabolism Case Reports (Apr 2017)

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

  • Adriana de Sousa Lages,
  • Isabel Paiva,
  • Patrícia Oliveira,
  • Francisco Portela,
  • Francisco Carrilho

DOI
https://doi.org/10.1530/EDM-16-0145
Journal volume & issue
Vol. 1, no. 1
pp. 1 – 5

Abstract

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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.