An insulinoma in which glycemic fluctuation was successfully managed preoperatively by octreotide subcutaneous injections

Abstract

A 78-year-old woman with dementia was transferred to our hospital with hypoglycemia. Insulinoma in the uncinate process of the pancreas was diagnosed based on the findings of enhanced abdominal CT, angiography and the clinical symptoms. We managed the hypoglycemia with an intravenous drip of glucose for preoperative management. This was difficult, because the patient repeatedly removed the intravenous drip herself. We therefore administered subcutaneous injections of octreotide as an alternative method, which was effective in managing her hypoglycemia. We performed enucleation of the tumor, the location of which was confirmed by intraoperative ultrasonography. A rapid insulin immunoassay was used to intraoperatively monitor the patient to confirm the absence of any remnant tumor. After surgery, the hypoglycemia disappeared and the patient has remained symptomfree. This case of insulinoma with preoperative hypoglycemia was successfully managed by subcutaneous injections of octreotide. This appears to be an effective treatment in cases difficult to manage by intravenous drip.