Peptide receptor radionuclide therapy for malignant insulinoma: New horizons

Malignant insulinoma is a rare neuroendocrine tumor, located exclusively in the pancreas, characterized by severe hypoglycemia secondary to excessive insulin secretion. Somatostatin analogs (SSA) and everolimus have been added to the classic treatment with diazoxide in the last years. Peptide receptor radionuclide therapy (PRRT) has also been recently tested in a few patients with insulinoma with apparently satisfactory results. We present a 49-year-old woman with a loss of consciousness in the context of severe hypoglycemia that was diagnosed of malignant insulinoma. She underwent tumor excision and a total pancreatectomy and after an extended hospital stay, she was discharged without hypoglycemia under treatment with ASS. After observing tumor progression, treatment with 4 cycles of PRRT was performed with symptomatic control, reduction of some of the metastatic lesions and stabilization of other lesions with excellent tolerance to treatment. PRRT is a possible alternative for the symptomatic and etiological treatment of malignant insulinoma.