Endocrinol Metab.  2013 Jun;28(2):149-152. 10.3803/EnM.2013.28.2.149.

Transformation of Nonfunctioning Pancreatic Neuroendocrine Carcinoma Cells into Insulin Producing Cells after Treatment with Sunitinib

• Ohn JH
• Kim YG
• Lee SH
• Jung HS

• KMID: 1973815
• DOI: http://doi.org/10.3803/EnM.2013.28.2.149

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.

Keyword

Sunitinib; Tyrosine kinase inhibitor; Pancreatic neuroendocrine tumor; Insulinoma; Hypoglycemia

MeSH Terms

Biopsy
C-Peptide
Carcinoma, Neuroendocrine
Emergencies
Fasting
Female
Humans
Hyperinsulinism
Hypoglycemia
Indoles
Insulin
Insulinoma
Liver
Lymph Nodes
Neoplasm Metastasis
Protein-Tyrosine Kinases
Pyrroles
Unconsciousness
C-Peptide
Indoles
Insulin
Protein-Tyrosine Kinases
Pyrroles

Figure

• 

  Fig. 1 Computed tomography scan of abdomen at the initial diagnosis of neuroendocrine carcinoma. Arrows indicate (A) pancreatic mass of 7 mm and (B) liver metastasis of 1.8 cm with contrast enhancement.

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  Fig. 2 Immunohistochemical stains for insulin (×200). (A) Negative stain of supraclavicular lymph node before sunitinib administration. (B) Positive stain of metastatic liver mass after sunitinib treatment.

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