Successful treatment of insulinoma by a single daily dose of octreotide in two elderly female patients.
Successful treatment of insulinoma by a single daily dose of octreotide in two elderly female patients.
复制标题
通过每日单剂奥曲肽成功治疗两名老年女性患者的胰岛素瘤。
作者：
H. Kishikawa;Y. Okada;A. Hirose;Takahisa Tanikawa;K. Kanda;Yoshiya Tanaka
我们报告了两例高龄患者的胰岛素瘤，他们被认为不适合手术，每天单次剂量的奥曲肽成功地改善了低血糖和高胰岛素血症。奥曲肽的生物半衰期约为100分钟，因此习惯上每天使用两到三次给药来预防胰岛素瘤患者的低血糖。首例为76岁女性，表现为高胰岛素血症。CT和磁共振成像未发现胰腺肿瘤，但腹部血管造影发现胰体内有1.5厘米长的肿瘤，选择性动脉钙刺激和肝静脉采血(ASV)与胰岛素瘤相适应。患者拒绝手术，但成功地使用了奥曲肽，每天皮下注射50微克。自治疗开始以来(1年)，她没有发生低血糖。例2为85岁女性，表现为高胰岛素血症。CT发现胰腺钩有一个1.5厘米长的肿瘤，但由于年龄较大、肥胖和心肺功能障碍，她被认为不适合手术。每天皮下注射一次100微克的奥曲肽可以防止进一步的低血糖发作，但两个月后，餐后血糖升高。奥曲肽逐渐减少到50微克，每天一次。自治疗以来，三年过去了，没有任何低血糖发作。奥曲肽每天成功治疗一次可能是由于老年相关的代谢缓慢，可能被认为是老年胰岛素瘤患者的治疗选择，特别是那些被认为不适合手术的患者。
We report two cases of insulinoma in advanced age patients considered unsuitable for surgery, in whom single daily doses of octreotide successfully improved hypoglycemia and hyperinsulinemia. The biological half-life of octreotide is about 100 min, hence it is customary to use two or three administrations per day to prevent hypoglycemia in insulinoma patients. The first case was a 76-year-old woman who presented with hyperinsulinemic hypoglycemia. Computed tomography (CT) and magnetic resonance imaging did not identify a tumor in the pancreas but a 1.5-cm tumor was found in the pancreatic body on abdominal angiography and selective arterial calcium stimulation and hepatic venous sampling (ASVS) were compatible with insulinoma. The patient refused surgery, but was successfully treated with octreotide at 50 microg subcutaneous injection once daily. Since the treatment was started (1 year), she has not suffered hypoglycemia. Case 2 was an 85-year-old woman who presented with hyperinsulinemic hypoglycemia. CT identified a 1.5-cm tumor in the pancreatic uncus, but she was considered unsuitable for surgery due to advanced age, obesity and cardiopulmonary dysfunction. Octreotide at 100 microg subcutaneous injection once daily prevented further hypoglycemic attacks, but two months later, postprandial plasma glucose was elevated. Octreotide was gradually reduced to 50 microg once daily. Three years have passed since the treatment without any hypoglycemic attack. Successful treatment with octreotide once daily could be due to old-age-related slow metabolism and could be potentially considered as the treatment of choice for elderly patients with insulinoma especially those considered unsuitable for surgery.