A Patient with Octreotide-ultrasensitive Insulinoma Whose Insulin Resistance Was Disclosed by Sudden Extreme Hyperglycemia upon Treatment

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  • Kodera Tsutomu
    Division of Endocrinology and Metabolism, Department of Medicine, National Defense Medical Cellege
  • Tozawa Michiko
    Division of Endocrinology and Metabolism, Department of Medicine, National Defense Medical Cellege
  • Yoshida Nobuyuki
    Division of Endocrinology and Metabolism, Department of Medicine, National Defense Medical Cellege
  • Koso Hiroshi
    Division of Endocrinology and Metabolism, Department of Medicine, National Defense Medical Cellege
  • Yoshida Rie
    Division of Endocrinology and Metabolism, Department of Medicine, National Defense Medical Cellege
  • Motoyoshi Kazuo
    Division of Endocrinology and Metabolism, Department of Medicine, National Defense Medical Cellege
  • Tanaka Yuji
    Division of Endocrinology and Metabolism, Department of Medicine, National Defense Medical Cellege

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Other Title
  • オクトレオチド投与により高血糖をきたし，少量に減少し病態の改善をみたインスリノーマの1例
  • 症例報告 オクトレオチド投与により高血糖をきたし,少量に減少し病態の改善をみたインスリノーマの1例
  • ショウレイ ホウコク オクトレオチド トウヨ ニ ヨリ コウケットウ オ キタシ ショウリョウ ニ ゲンショウ シ ビョウタイ ノ カイゼン オ ミタ インスリノーマ ノ 1レイ

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Abstract

We report an elderly patient with insulinoma in whom severe hyperglycemia was induced by octreotide, and who was finally treated with a minimal dose of the agent. An 89-year-old woman found to be hypoglycemic (20 mg/dl) experienced morning faintness. Her plasma insulin was 12 μg/ml and C-peptide 3.3 mg/dl during hypoglycemia. We diagnosed insulinoma as her counter-regulatory hormones responded normally, chromogranin A was markedly elevated, and a tumor was detected at the pancreas head. In consideration of her age and a dissecting aneurysm, we selected octreotide treatment. Upon the administration of 50 μg of octreotide, her plasma glucose rose to 555 mg/dl, which finally recovered 36 hours later. After titration, we found that a dose of 10 μg/day was optimal to control plasma glucose and to avoid hypoglycemic faintness. Octreotide is often used for insulinoma treatment; however, a dose as low as 10 μg/day is unusual. The reaction may have been due to the tumor expression of hypersensitive subtype receptor(s) of somatostatin or its analogs. This mechanism, together with insulin resistance as an adaptation phenomenon against prolonged hyperinsulinemia, could also explain why octreotide, which usually does not induce hyperglycemia in any situation, caused hyperglycemia in this patient.

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