Insulinoma medical therapy: Difference between revisions
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===1. '''Adult'''=== | ===1. '''Adult'''=== | ||
*'''Parenteral''' | *'''Parenteral''' | ||
** Preferred regimen (1): Octreotide 30 mg IM (depot) every 4 weeks until tumor progression or death | ** Preferred regimen (1): [[Octreotide]] 30 mg IM (depot) every 4 weeks until tumor progression or death | ||
** Preferred regimen (2): Octreotide 100-500 μg SQ q 8-12h（can be increased to maximum 1500 μg daily）for 1 year | ** Preferred regimen (2): [[Octreotide]] 100-500 μg SQ q 8-12h（can be increased to maximum 1500 μg daily）for 1 year | ||
** Preferred regimen (3): [[Lanreotide]] 120 mg SQ every 4 weeks until tumor progression | |||
*'''Oral''' | *'''Oral''' | ||
**Preferred regimen : Diazoxide 3-8 mg/kg OR 200-300 mg PO q8h for 14-21 days (1200 mg max to be divided in 3 doses and max is 400 mg/dose)<ref name="pmid3019020">{{cite journal |vauthors=Goode PN, Farndon JR, Anderson J, Johnston ID, Morte JA |title=Diazoxide in the management of patients with insulinoma |journal=World J Surg |volume=10 |issue=4 |pages=586–92 |year=1986 |pmid=3019020 |doi= |url=}}</ref><ref name="pmid9497974">{{cite journal |vauthors=Gill GV, Rauf O, MacFarlane IA |title=Diazoxide treatment for insulinoma: a national UK survey |journal=Postgrad Med J |volume=73 |issue=864 |pages=640–1 |year=1997 |pmid=9497974 |pmc=2431498 |doi= |url=}}</ref> | **Preferred regimen : [[Diazoxide]] 3-8 mg/kg OR 200-300 mg PO q8h for 14-21 days (1200 mg max to be divided in 3 doses and max is 400 mg/dose)<ref name="pmid3019020">{{cite journal |vauthors=Goode PN, Farndon JR, Anderson J, Johnston ID, Morte JA |title=Diazoxide in the management of patients with insulinoma |journal=World J Surg |volume=10 |issue=4 |pages=586–92 |year=1986 |pmid=3019020 |doi= |url=}}</ref><ref name="pmid9497974">{{cite journal |vauthors=Gill GV, Rauf O, MacFarlane IA |title=Diazoxide treatment for insulinoma: a national UK survey |journal=Postgrad Med J |volume=73 |issue=864 |pages=640–1 |year=1997 |pmid=9497974 |pmc=2431498 |doi= |url=}}</ref> | ||
** Alternative regimen(1): Phenytoin 300-600 mg PO q daily<ref name="MathurGorden2009">{{cite journal|last1=Mathur|first1=Aarti|last2=Gorden|first2=Philip|last3=Libutti|first3=Steven K.|title=Insulinoma|journal=Surgical Clinics of North America|volume=89|issue=5|year=2009|pages=1105–1121|issn=00396109|doi=10.1016/j.suc.2009.06.009}}</ref> | ** Alternative regimen(1): [[Phenytoin]] 300-600 mg PO q daily<ref name="MathurGorden2009">{{cite journal|last1=Mathur|first1=Aarti|last2=Gorden|first2=Philip|last3=Libutti|first3=Steven K.|title=Insulinoma|journal=Surgical Clinics of North America|volume=89|issue=5|year=2009|pages=1105–1121|issn=00396109|doi=10.1016/j.suc.2009.06.009}}</ref> | ||
**Alternative regimen (2): [[Everolimus]] 10 mg PO q daily until disease progression | **Alternative regimen (2): [[Everolimus]] 10 mg PO q daily until disease progression | ||
**[[Verapamil]] and [[Propranolol]] to control symptoms are used either as alone or in combination | **[[Verapamil]] and [[Propranolol]] to control symptoms are used either as alone or in combination | ||
**[[Glucocorticoids]] and [[Glucagon]] have been used in combination with diazoxide. | **[[Glucocorticoids]] and [[Glucagon]] have been used in combination with diazoxide. | ||
===2.'''Pediatric'''=== | ===2.'''Pediatric'''=== | ||
Revision as of 13:25, 7 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief: Amandeep Singh M.D.[4] Parminder Dhingra, M.D. [5]
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Risk calculators and risk factors for Insulinoma medical therapy |
Overview
The predominant therapy for insulinoma is surgical resection. Supportive therapy for insulinoma includes octerotide, endoscopic ultrasound guided alcohol ablation, radiofrequency ablation, embolization, diazoxide and chemotherapy.
Medical Therapy
The medical therapy of insulinoma include:[1][2][3]
- Octreotide
- Endoscopic ultrasound guided alcohol ablation
- Radiofrequency ablation (RFA)
- Embolization
- Diazoxide
- Combination chemotherapy
- Doxorubicin AND Streptozotocin
- Fluorouracil AND Streptozotocin (when doxorubicin is contraindicated)
Overview
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
- The primary treatment is surgical excision. Medical therapy is reserved for:
- Those who can't undergo surgery
- High-risk patients
- Unresectable metastatic disease
- Those who refuse to undergo surgery
- Those who can't undergo surgery
- The medical therapy is mainly used to reduce/prevent symptoms of hypoglycemia
- Pharmacologic medical therapies for insulinoma include Diazoxide, Octreotide/Lanreotide, and Phenytoin
Benign Insulinoma
1. Adult
- Parenteral
- Preferred regimen (1): Octreotide 30 mg IM (depot) every 4 weeks until tumor progression or death
- Preferred regimen (2): Octreotide 100-500 μg SQ q 8-12h（can be increased to maximum 1500 μg daily）for 1 year
- Preferred regimen (3): Lanreotide 120 mg SQ every 4 weeks until tumor progression
- Oral
- Preferred regimen : Diazoxide 3-8 mg/kg OR 200-300 mg PO q8h for 14-21 days (1200 mg max to be divided in 3 doses and max is 400 mg/dose)[4][5]
- Alternative regimen(1): Phenytoin 300-600 mg PO q daily[6]
- Alternative regimen (2): Everolimus 10 mg PO q daily until disease progression
- Verapamil and Propranolol to control symptoms are used either as alone or in combination
- Glucocorticoids and Glucagon have been used in combination with diazoxide.
2.Pediatric
2.1 Neonates and Infants
- Oral
- Preferred regimen: Diazoxide initial dose: 10 mg/kg/day divided into 3 equal doses q 8 hours;
Maintenance dosing range: 8 to 15 mg/kg/day divided into 2 or 3 equal doses every 8 to 12 hours. 2.2 Children and adolescents- follow the adult regimen
Malignant Insulinoma
Chemotherapy
- Streptozocin
- Doxorubicin
- 5 FluoroUracil(5-FU)
References
- ↑ Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y; et al. (2013). "Diagnosis and management of insulinoma". World J Gastroenterol. 19 (6): 829–37. doi:10.3748/wjg.v19.i6.829. PMC 3574879. PMID 23430217.
- ↑ Insulinoma. National cancer institute. [1]
- ↑ Insulinoma. National cancer institute. [2]
- ↑ Goode PN, Farndon JR, Anderson J, Johnston ID, Morte JA (1986). "Diazoxide in the management of patients with insulinoma". World J Surg. 10 (4): 586–92. PMID 3019020.
- ↑ Gill GV, Rauf O, MacFarlane IA (1997). "Diazoxide treatment for insulinoma: a national UK survey". Postgrad Med J. 73 (864): 640–1. PMC 2431498. PMID 9497974.
- ↑ Mathur, Aarti; Gorden, Philip; Libutti, Steven K. (2009). "Insulinoma". Surgical Clinics of North America. 89 (5): 1105–1121. doi:10.1016/j.suc.2009.06.009. ISSN 0039-6109.