Malignant Insulinoma Arising From Nonfunctioning Pancreatic Neuroendocrine Tumor

Ritodhi Chatterjee; Basim Ali; Son H Nguyen; Rui Chen; Yvonne H Sada

doi:10.14309/crj.0000000000000954

Malignant Insulinoma Arising From Nonfunctioning Pancreatic Neuroendocrine Tumor

ACG Case Rep J. 2023 Jan 27;10(1):e00954. doi: 10.14309/crj.0000000000000954. eCollection 2023 Jan.

Authors

Ritodhi Chatterjee¹, Basim Ali¹, Son H Nguyen², Rui Chen², Yvonne H Sada³

Affiliations

¹ Department of Internal Medicine, Baylor College of Medicine, Houston, TX.
² Section of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Baylor College of Medicine, Houston, TX.
³ Section of Hematology and Oncology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX.

Abstract

Pancreatic neuroendocrine tumors are rare neoplasms characterized into nonfunctioning (NF-PNET) and functioning (F-PNET) subtypes. F-PNETs typically involve overt symptoms related to excessive hormone secretion but may rarely present first as NF-PNETs with delayed transformation. We present a patient with known NF-PNET with liver metastases who developed hypoglycemia 2 years after initial diagnosis due to malignant insulinoma. Hypoglycemia was refractory to continuous dextrose but improved temporarily after diazoxide and hepatic artery embolization. Malignant insulinomas are usually metastatic at presentation and portend poor prognosis. Hypoglycemia may be medically managed with steroids, somatostatin analogues, and diazoxide, along with therapies to reduce tumor burden.

Keywords: diazoxide; hepatic artery embolization; insulinoma; liver metastases; pancreatic neuroendocrine tumor.

Publication types

Case Reports