Pasireotide use for the treatment of endogenous hyperinsulinemic hypoglycemia refractory to conventional medical therapy: A case report and review of the literature

• Published in: Clinical case reports Vol. 10; no. 3; pp. e05650 - n/a
• Main Authors: Husni, Hasan, Khan, Sara A., Alghaieb, Buraq, Abusamaan, Mohammed S., Donner, Thomas W., Hamrahian, Amir H.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-03-2022; John Wiley and Sons Inc; Wiley
• Subjects: Case Report; Case Reports; Chronic obstructive pulmonary disease; Consciousness; Fainting; Fasting; Fractures; Glucose; Hospitals; Hypoglycemia; Insulin; insulinoma; Localization; neuroendocrine tumor; Neuroendocrine tumors; Nursing homes; Pancreas; pasireotide; Peptides; refractory hypoglycemia; Veins & arteries; neuroendocrine tumor; refractory hypoglycemia; pasireotide; insulinoma
• ISSN: 2050-0904; 2050-0904
• DOI: 10.1002/ccr3.5650

Insulinomas are rare neuroendocrine pancreatic tumors that can be associated with severe episodes of hypoglycemia, leading to significant morbidity and mortality. These tumors are often difficult to localize, and hypoglycemia control can be challenging since glucose levels can be resistant to conventional therapies. Pasireotide is a novel somatostatin analog with a high affinity to multiple somatostatin receptors. It has up to 40 times higher affinity for somatostatin receptor subtype 5 in comparison with octreotide, leading to a higher inhibition of insulin release from beta cells. There are few case reports regarding the use of pasireotide in refractory hyperinsulinemic hypoglycemia. We describe a challenging case of endogenous hyperinsulinemic hypoglycemia refractory to standard medical treatment, in which pasireotide was used. In this case, imaging studies and calcium stimulation testing failed to localize an insulin‐secreting tumor in an 83‐year‐old woman. Glucose levels remained low despite treatment with diazoxide, verapamil, and octreotide, necessitating the use of IV dextrose solutions. After starting subcutaneous (SC) pasireotide 0.9 mg twice a day, there was a significant improvement in the frequency and severity of hypoglycemic events, allowing the patient to be discharged from the hospital without needing IV glucose support.
Insulinomas are rare neuroendocrine pancreatic tumors that can be associated with severe refractory hypoglycemia. Pasireotide, a novel somatostatin analog, led to significant improvement in the frequency and severity of hypoglycemic events, allowing the patient to discontinue IV glucose.