Insulinoma medical therapy

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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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:

• 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
• The medical therapy is mainly used to reduce/prevent symptoms of hypoglycemia
• Pharmacologic medical therapies for insulinoma include Diazoxide, Octreotide/Lanreotide, and Phenytoin

1.Adult

• Parenteral
  • Preferred regimen : Octreotide 50 μg SQ q 8-12h（can be increased to maximum 1500 μg daily）for 1 year
• Oral
  • Preferred regimen : Diazoxide 3-8 mg/kg 200-300 mg PO q8h for 14-21 days (1200mg max to be divided in 3 doses and max is 400mg/dose)
  • Alternative regimen: Phenytoin 300-600 mg PO q daily