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Am J Med Sci. 2010 Nov;340(5):414-7. doi: 10.1097/MAJ.0b013e3181ee7be2.

Management of intractable hypoglycemia with Yttirum-90 radioembolization in a patient with malignant insulinoma.

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Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA.


Metastatic insulinomas may present with recurrent life-threatening hypoglycemia. Treatment of hypoglycemia in such patients is difficult and frequently fails to respond to numerous therapeutic agents, requiring continuous dextrose infusion. The authors present our experience with Yttirum-90 radioembolization in a patient with metastatic malignant insulinoma who failed to respond to distal pancreatectomy, systemic chemotherapy with capecitabine and everolimus and medical treatment with somatostatin analogues, diazoxide and corticosteroids. Treatment with repeated Y-90 radioembolization resulted in rapid resolution of hypoglycemic events, allowing discontinuation of dextrose infusion and hospital discharge. However, the effect of Y-90 administration seems to be transient and without evidence of tumor shrinkage in imaging studies.

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