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Endocrine Abstracts (2006) 11 P499

Endocrine tumours and neoplasia

Long-term somatostatin analog octreotide treatment in insulinoma patients

D Vezzosi1, A Bennet1, F Courbon2 & P Caron1


1Endocrinology, Toulouse, France; 2Nuclear Medicine, Toulouse, France.


The usefulness of long-term medical treatment with somatostatin analogs has not been evaluated in insulinomas. 22 patients with hypoglycaemia related to endogenous hyperinsulinism (62±21 years, M±S.D., 27–88 years) were not treated by surgery: aged patients (n=10), patients with malignant unresectable insulinomas (n=6; locally invasive, n=1; multimetastatic, n=5), multiple insulinomas (n=2), diffuse beta cell pathology (n=4). 12/22 patients underwent an Octreoscan scintigraphy. Octreotide was effective in controlling hypoglycaemia in 13/22 patients (59%): 7 aged patients, 1 patient with an invasive insulinoma, 2 with multiple insulinomas and 3 with diffuse beta cell pathology. Octreoscan scintigraphy was positive in 6/12 patients: 2 were responsive and 4 unresponsive to octreotide. Octreoscan scintigraphy was negative in the other 6/12 patients: however 3 of these patients were responsive to octreotide. Subcutaneous octreotide treatment was prolonged for more than 6 months (6 months-12 years, 5.3±4.0 years) in 10 of the 13 responders (6 elderly patients, 1 invasive insulinoma, 2 multiple insulinomas, 1 nesidioblastosis) at a dose of 50–2000 μg/day (495±600 μg/day). No escape to therapy was observed. However, the dose of octreotide had to be increased in 2 patients after 2 months (n=1), and after 7 years (n=1). In a patient with multiple insulinomas, subcutaneous octreotide was replaced by a long-acting somatostatin analog preparation with the same efficacy. The malignant invasive insulinoma remained asymptomatic and unchanged on CT-scan evaluation after 2 years of follow-up. Only 1 patient suffered from a symptomatic biliary lithiasis after 3 years of treatment. In conclusion, Octreoscan scintigraphy is not predictive of the efficacy of octreotide on hypoglycaemia in insulinoma patients; long-term octreotide treatment can be used to control hypoglycaemia in patients with insulinoma who cannot be cured by surgery.

Volume 11

8th European Congress of Endocrinology incorporating the British Endocrine Societies

European Society of Endocrinology 
British Endocrine Societies 

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