Abstract
A 55-year-old female presented with recurring episodes of loss or decline in the quality of consciousness due to hypoglycaemia caused by insulin overproduction in hormonally active metastatic pancreatic insulinoma. All standard anticancer treatment modalities including chemotherapy, radiation, interferon alpha 2b, and lanreotide failed to achieve symptomatic control. The patient became dependent on continuous intravenous glucose supply. Based on anecdotal reports in literature, prednisone therapy was started in order to increase insulin resistance, reduce glucose utilization, increase hepatic glucose production, and impair insulin secretion. After 10 days of therapy, the patient was released from continuous intravenous glucose infusion. After several weeks, administration of prednisone was lowered to a daily maintenance dose of 2.5 mg with excellent symptomatic effects. In conclusion, prednisone therapy may be considered as a valid option to achieve symptomatic control in hormonally active therapeutically resistant insulinomas.
References
Powers AC (2001) Diabetes Mellitus. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson J (Eds) Harrison’s principles of internal medicine, 15th edn. McGraw-Hill, New York, pp 2109–2137
Finlayson E, Clark OH (2004) Surgical treatment of insulinomas. Surg Clin North Am 84:775–785
Philippe J, Missotten M (1990) Dexamethasone inhibits biosynthesis by destabilizing insulin messenger ribonucleic acid in hamster insulinoma cell. Endocrinology 127:1640–1645
Sadoff L, Gordon J, Goldman S (1975) Amelioration of hypoglycaemia in a patient with malignant insulinoma during the development of the ectopic ACTH syndrome. Diabetes 24:600–603
Debreceni L, Meszaros I (1987) Persistent hypoglycaemia due to hyperinsulinemia, hypoglucagonemia and mild adrenal insufficiency. Exp Clin Endocrinol 90:221–226
Acknowledgement
Supported by MSM 002 162 0808.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Novotny, J., Janku, F., Mares, P. et al. Symptomatic control of hypoglycaemia with prednisone in refractory metastatic pancreatic insulinoma. Support Care Cancer 13, 760–762 (2005). https://doi.org/10.1007/s00520-005-0840-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-005-0840-5