Radiofrequency ablation of solitary pancreatic insulinoma in a patient with episodes of severe hypoglycemia

Insulinomas are rare neuroendocrine tumors of the pancreas. Therapy of first choice is the surgical resection or enucleation. In cases of metastases or in patients with high surgical risk, medical therapy with diazoxide or octreotide is an alternative. In this case, we describe the successful use of computed tomography (CT)-guided radiofrequency ablation (RFA) of an insulinoma in an 80-year-old female patient. The patient suffered from episodes of severe nightly hypoglycemia with a minimal glucose concentration of 1.95 mmol/l (36 mg/dl). An insulinoma measuring 1.5 cm in diameter was localized by endoscopic ultrasound and CT scan in the tail of the pancreas. Owing to a high surgical risk caused by the patient's comorbidities and poor physical condition, the resection of the tumor was not considered. The medical treatment with diazoxide failed to control the symptoms of hypoglycemia sufficiently. Using CT-guided percutaneous RFA, the insulinoma was successfully ablated. No postinterventional complications occurred. During a 5-week follow-up, episodes of hypoglycemia were absent. A control-CT, 5 weeks after RFA, revealed no residual tumor. In conclusion, we found RFA suitable for the treatment of pancreatic insulinomas. Until more data concerning efficacy and complication rates have been collected; the procedure should be reserved for the treatment of patients who are no candidates for surgical therapy and in whom symptoms cannot be controlled by the medical therapy. Eur J Gastroenterol Hepatol 21: 1097-1101 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.