Medical Treatment of Insulinoma

Summary

The treatment of insulinoma is mainly surgical; i.e. enucleation of the tumour or partial pancreatectomy. Metastase, recurrence of the tumour, poor general health of the patient or his refusal of surgery urge to alternative (medical) therapy. In recent years some drugs have been developed which can abate the troublesome and dangerous symptoms of hypoglycemia, or may affect directly the tumourmass.

Diazoxide (Proglicem®) is the most specific and effective drug. The most important side-effect is its salt-retaining action with development of ankle edema and hypertension: frequent control of blood-pressure and body-weight are required. These side effects can be treated with thiazide diuretics. Another disadvantage is the rather high cost °f treatment.

Streptozotocin (Streptozocin®) is the only antimitotic with specific action on the malignant β-cell. Due to this moderate—mainly renal—toxicity, it is the treatment of choice for metastatic insulinoma; eventually one can resort to another antimitotic if the symptoms persist and the tumour grows. Because no other drug as the same specificity for the β-cell as Streptozotocin, the choice depends more on personal experience with other drugs. A survey of the literature leads us to the conclusion that adriamycin and 5-F U (eventually combined with Streptozocin“) give the best results in patients with relapsing Streptozotocin-resistent metastatic msulinoma.