الإنسولينوما المتقدمة (غير القابلة للاستئصال/النقيلية): ما الذي يجب فعله عندما لم يسيطر علاج الخط الأول على نقص سكر الدم

References

DOI: 10.1111/jne.13318

• The management of functioning Pan-NET syndromes in patients with advanced disease, that is, unresectable or metastatic, requires a multimodal approach consisting of supportive, medical, interventional and surgical treatment.
• SSA can reduce insulin levels and prevent hypoglycaemic episodes in patients with advanced insulinomas.
• As SSA also decrease glucagon secretion and SSTR expression can be limited in insulinomas, which could paradoxically aggravate hypoglycaemia, a trial with short-acting octreotide under close monitoring of glucose levels is advised.
• After demonstration of a positive effect on glucose levels, long-acting release (LAR) octreotide or lanreotide can be initiated.
• In cases with advanced insulinoma with hypoglycaemia refractory to octreotide or lanreotide, the pan-somatostatin receptor-targeting pasireotide can be tried off-label.