Introduction: It is believed that hypoglycemia in the elderly is a dangerous condition and may result in stroke and death. We observed five female patients with insulinoma and over 20-year-long survival.
Material: The material includes five female with the diagnosis of insulinoma. Patients age ranged from 78 to 91 years while disease duration ranged from 21 to 34 years.
Methods: In all the patients, the diagnosis of insulinoma was based on glucose, insulin and C-peptide levels in the fasting test, while the presence of focal lesion in the pancreas was confirmed in CT, MRI and EUS.
Results: At the time of diagnosis, mean fasting glucose level was 31.4 mg/dl (±9.6), insulin 19.5 μIU/ml (±14.2) and c-peptide 8.2 ng/ml (±4.9). In three patients, disease progression was observed after many years of diazoxide therapy. These women have not been qualified for surgery because of their general status. Alcohol ablation of insulinoma was attempted in three patients, but the relief of clinical symptoms after EUS-guided administration of 5 ml ethanol was obtained in only one patient. In the remaining two women, the procedure could not be performed for technical reasons. These patients had receptor scintigraphy with octreotide and blood glucose levels were evaluated in the test with 100 mg octreotide significant increase in glucose levels was observed in hours 5, 6 and further on, persisting up to 12 h (mean baseline glucose level 41.7 mg/dl; glucose levels following octreotide administration in subsequent hours 163, 195, 221 mg/dl). In both patients, long-acting somatostatin analogues were started with good clinical effect.
Conclusion: Ethanol ablation of insulinoma and treatment with somatostatin analogues is an alternative in patients who are not good candidates for surgery and in whom diazoxide therapy is ineffective.