Endocrine Abstracts

An 82-year-old lady admitted after multiple episodes of collapse and her blood sugar levels were noted to be less than 2.0 mmol/l. A supervised controlled fasting test was performed and results were consistent with Insulinoma. Imaging revealed a mass in the tail of the pancreas with metastasis to the liver. Liver biopsy confirmed the diagnosis of a poorly differentiated neuroendocrine tumour. She continued to have hypoglycaemic episodes which were difficult to manage. Dietary modifications and intravenous glucose had no success. Treatment with diazoxide and later with lanreotide, bore no success. Case was discussed in the surgical MDT which concluded that surgery was not an option. Further discussion in endocrine MDT advised a modified corn-starch product – glycoside should be tried. Glycosade is a long acting carbohydrate which is used in the treatment of glycogen storage diseases as the carbohydrate is slowly released. Glycosade is not currently licenced for use in insulinomas but was considered in this case due to its long-acting benefits. Response was great to the point of her not requiring any further intravenous glucose or dietary modifications. Further oncology commenced her on chemotherapy using streptozocin and capecitabine. Everolimus, could not be used because of high proliferation index noted on histology. The glycosade regimen was spread out throughout the day to allow stabilisation of the patient’s glucose levels. As an inpatient and even after discharge patient’s blood glucose levels have maintained between 4-9 mmol/l