Endocrine Pathology

, Volume 29, Issue 1, pp 15–20 | Cite as

Pancreatic Neuroendocrine Tumor Producing Insulin and Vasopressin

  • Omalkhaire M. Alshaikh
  • Ju-Yoon Yoon
  • Bryan A. Chan
  • Monika K. Krzyzanowska
  • Jagdish Butany
  • Sylvia L. Asa
  • Shereen Ezzat


The objective of the study is to report a rare case of pancreatic neuroendocrine tumor (pNET) producing insulin and vasopressin. We describe the clinical presentation and management of a metastatic pNET with refractory hypoglycemia and progressive severe hyponatremia. A 52-year-old patient had abdominal pain leading to the diagnosis of a tumor that was initially presumed to be splenic in origin. Investigations ultimately identified a pancreatic mass that on biopsy proved to be a pNET. Eventually, he developed extensive liver metastases, and with tumor progression, he manifested hypoglycemia and severe hyponatremia. He was managed with multiple therapies including somatostatin analogue, peptide-receptor-radionuclide-therapy (PRRT), diazoxide, and everolimus; none of these therapeutic modalities was successful in controlling functional and structural progression of the tumor. Ultimately, the pNET proved fatal and autopsy confirmed widely metastatic disease that stained strongly and diffusely for vasopressin, a feature not seen in the previous liver biopsy. This case illustrates the challenges of diagnosis and management of aggressive insulin-producing pNETs and highlights the potential concomitant ectopic production of vasopressin leading to refractory hyponatremia.


Pancreatic neuroendocrine tumors Neuroendocrine tumors Insulin Vasopressin 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Omalkhaire M. Alshaikh
    • 1
    • 2
  • Ju-Yoon Yoon
    • 3
  • Bryan A. Chan
    • 2
  • Monika K. Krzyzanowska
    • 2
  • Jagdish Butany
    • 3
  • Sylvia L. Asa
    • 3
  • Shereen Ezzat
    • 2
  1. 1.Department of Internal MedicineAl Imam Mohammad Ibn Saud Islamic University (IMSIU)RiyadhSaudi Arabia
  2. 2.Department of Medicine, Princess Margaret Cancer CentreUniversity Health NetworkTorontoCanada
  3. 3.Department of Pathology, University Health NetworkUniversity of TorontoTorontoCanada

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