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      Successful medical management of insulinoma with diazoxide for 27 years

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          Abstract

          Summary

          Despite improvements in localisation techniques and surgical advances, some patients with insulinoma will not be cured by surgery or may not be suitable for surgery. Medical management with diazoxide is an option for such cases. This case report details 27 years of successful management of insulinoma using diazoxide. It has been effective and safe, with only minor adverse effects.

          Learning points:
          • Long term diazoxide use can be a safe, effective option for insulinoma when it cannot be localised or removed surgically.

          • Common adverse effects include peripheral oedema, hyperuricaemia, and hirsutism.

          • 68Ga-NOTA-exendin-4 PET/CT scan should be considered for insulinoma localisation when other modalities have been unhelpful.

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          Most cited references5

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          Diazoxide treatment for insulinoma: a national UK survey.

          A survey of UK patients receiving the drug diazoxide, revealed 40 patients with insulinoma on this treatment. Mean age (+/- SD) was 67 +/- 18 years, and 74% were female. Duration of treatment was 7 +/- 6 years (range 1-22). Most (55%) patients were treated with diazoxide because of tumour non-localisation (including failed previous surgery). Metastatic disease (20%) and poor surgical risk (10%) were other indications. Side-effects (notably fluid retention and hirsutism) were common (47%) but not troublesome. Treatment was highly effective--59% were symptom free and 38% had only occasional symptoms. Only one patient had frequent hypoglycaemia despite treatment. We conclude that diazoxide is effective in the management of insulinoma. Side-effects are common but not problematic. Treatment should be considered for all patients not cured by surgery, or unsuitable for surgical treatment.
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            US-guided ethanol ablation of insulinomas: a new treatment option.

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              Diazoxide in the management of patients with insulinoma.

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                Author and article information

                Journal
                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                EDM
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                2052-0573
                10 September 2020
                2020
                : 2020
                : 20-0132
                Affiliations
                [1 ]Department of Endocrinology and Diabetes , Alfred Health, Melbourne, Victoria, Australia
                [2 ]Monash University , Central Clinical School, Melbourne, Victoria, Australia
                [3 ]Department of Endocrinology and Diabetes , Western Health, Melbourne, Victoria, Australia
                [4 ]Department of Medicine , Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
                Author notes
                Correspondence should be addressed to P S Hamblin; Email: peter.hamblin@ 123456wh.org.au
                Author information
                http://orcid.org/0000-0002-6280-865X
                Article
                EDM200132
                10.1530/EDM-20-0132
                7576657
                33434168
                2b1655c7-921e-414f-a779-fb4fb732e40b
                © 2020 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                History
                : 27 August 2020
                : 10 September 2020
                Categories
                Adult
                Male
                White
                Australia
                Pancreas
                Diabetes
                General practice
                Psychology/Psychiatry
                Novel Treatment
                Novel Treatment

                adult,male,white,australia,pancreas,diabetes,general practice,psychology/psychiatry,novel treatment,october,2020

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