Transformation of Nonfunctioning Pancreatic Neuroendocrine Carcinoma Cells into Insulin Producing Cells after Treatment with Sunitinib.
10.3803/EnM.2013.28.2.149
- Author:
Jung Hun OHN
1
;
Yeong Gi KIM
;
Se Hoon LEE
;
Hye Seung JUNG
Author Information
1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. junghs@snu.ac.kr
- Publication Type:Case Report
- Keywords:
Sunitinib;
Tyrosine kinase inhibitor;
Pancreatic neuroendocrine tumor;
Insulinoma;
Hypoglycemia
- MeSH:
Biopsy;
C-Peptide;
Carcinoma, Neuroendocrine;
Emergencies;
Fasting;
Female;
Humans;
Hyperinsulinism;
Hypoglycemia;
Indoles;
Insulin;
Insulinoma;
Liver;
Lymph Nodes;
Neoplasm Metastasis;
Protein-Tyrosine Kinases;
Pyrroles;
Unconsciousness
- From:Endocrinology and Metabolism
2013;28(2):149-152
- CountryRepublic of Korea
- Language:English
-
Abstract:
We report a rare case of severe hypoglycemia after sunitinib treatment for pancreatic neuroendocrine carcinoma. We describe the initial clinical presentation, laboratory results, pathologic findings, and managment in a patient with a nonfunctioning pancreatic neuroendocrine carcinoma with liver metastases who developed life threatening hypoglycemia after 2 months of sunitinib therapy. A 46-year-old woman presented to the emergency department with loss of consciousness from hypoglycemia. Serum C-peptide and insulin levels at fasting state revealed that the hypoglycemia resulted from endogenous hyperinsulinemia. She had been diagnosed with nonfunctioning pancreatic neuroendocrine carcinoma based on a biopsy of metastatic cervical lymph node and was being treated with sunitinib, a small molecule tyrosine kinase inhibitor. Immunohistochemical stain of the metastatic liver mass demonstrated that the initially nonfunctioning neuroendocrine carcinoma cells had changed into insulin-producing cells after sunitinib therapy. Transarterial chemoembolization of the liver masses and systemic chemotherapy with streptozotocin/adriamycin relieved the hypoglycemia. A nonfunctioning pancreatic neuroendocrine carcinoma was transformed into an insulin-producing tumor after treatment with sunitinib, causing endogenous hyperinsulinemia and severe hypoglycemia.
