Post-surgical
Following successful surgery and if all tumours were excised, most patients with an insulinoma or tumour secreting insulin-like growth factor (IGF)-II are cured of their disease. A small portion of individuals may have re-growth of a partially excised tumour or growth of a metastasis and subsequently require repeat surgery, chronic medical therapy, or directed therapy for malignant disease.[7]Service FJ, McMahon MM, O'Brien PC, et al. Functioning insulinoma - incidence, recurrence and long term survival of patients: a 60 year study. Mayo Clin Proc. 1991 Jul;66(7):711-9.
http://www.ncbi.nlm.nih.gov/pubmed/1677058?tool=bestpractice.com
Medically managed insulinoma
The medical options for the management of an insulinoma are limited and not as effective as surgical resection. Of the available medications diazoxide has been the most effective agent, although complications are common.[47]Stephen AE, Hodin RA. Neuroendocrine tumors of the pancreas, excluding gastrinoma. Surg Oncol Clin North Am. 2006 Jul;15(3):497-510.
http://www.ncbi.nlm.nih.gov/pubmed/16882494?tool=bestpractice.com
[48]Hirshberg B, Cochran C, Skarulis MC, et al. Malignant insulinoma: spectrum of unusual clinical features. Cancer. 2005 Jul 15;104(2):264-72.
http://www.ncbi.nlm.nih.gov/pubmed/15937909?tool=bestpractice.com
[49]Hofeldt FD, Dippe SE, Levin SR, et al. Effects of diphenylhydantoin upon glucose-induced insulin secretion in three patients with insulinoma. Diabetes. 1974 Mar;23(3):192-8.
http://www.ncbi.nlm.nih.gov/pubmed/4361409?tool=bestpractice.com
[50]Ricci S, Antonuzzo A, Galli L, et al. Long-acting depot lanreotide in the treatment of patients with advanced neuroendocrine tumors. Am J Clin Oncol. 2000 Aug;23(4):412-5.
http://www.ncbi.nlm.nih.gov/pubmed/10955874?tool=bestpractice.com
Inoperable IGF-II-secreting tumours
For the patient with an IGF-II-hypersecreting tumour who is not an operable candidate, there is a strong possibility of becoming refractory to the use of glucagon to support glucose levels. Few studies exist on other alternatives, although oral glucocorticoid administration has worked well in some case studies.[55]Tsuro K, Kojima H, Okamoto S, et al. Glucocorticoid therapy ameliorated hypoglycemia in insulin-like growth factor-II-producing solitary fibrous tumor. Intern Med. 2006;45(8):525-9.
https://www.jstage.jst.go.jp/article/internalmedicine/45/8/45_8_525/_pdf
http://www.ncbi.nlm.nih.gov/pubmed/16702745?tool=bestpractice.com
Exposure-related hypoglycaemia
Patients with factitious or drug exposure-induced hypoglycaemia have a favourable outlook. Symptoms should not recur so long as surreptitious use of insulin and offending medications are avoided.