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SUN-268 Radiofrequency Ablation of Insulinoma with Significant Post-Procedural Hyperglycemia in Setting of Glucocorticoids

Year: 2025
Type: article
Study design: Case Report
Abstract: Disclosure: A. Alcantara: None. M. Trieu: None. A.L. Dominguez: None. Background: In this case we present a patient with an insulinoma who underwent radiofrequency ablation with subsequent hyperglycemia secondary to glucocorticoids. Case: An 80-year-old female with history of type 2 diabetes mellitus, asthma/COPD overlap, morbid obesity, and colon cancer with partial colectomy presented with persistent hypoglycemia and was found to have a 1.9 cm well-differentiated pancreatic neuroendocrine tumor. The patient was diagnosed with diabetes over 20 years ago and was previously on metformin and empagliflozin, which were recently discontinued due to hypoglycemic episodes. Labs on presentation were notable for hemoglobin A1c 5.7%, TSH 3.48 mIU/L, and free T4 1.31 ng/dL. 72-hour fasting results revealed a venous glucose of 58 mg/dL, plasma insulin level 24.4 uIU/mL, plasma C-peptide 3.51 ng/mL, plasma proinsulin 12.9 pmol/L, beta-hydroxybutyrate 0.8 mg/dL, and an increase in plasma glucose to 60 mg/dL after IV glucagon was administered, supporting a diagnosis of insulinoma. The patient was started on diazoxide, while increasing the concentration of dextrose-containing maintenance fluids given episodic hypoglycemia and concern for volume overload. Due to the patient’s poor surgical candidacy, the decision was made to pursue endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA), which was well-tolerated. No further episodes of hypoglycemia occurred, and diazoxide was discontinued. The hospital course was complicated by asthma/COPD exacerbation that required initiation of glucocorticoids, leading to persistent hyperglycemia and requiring insulin. Following completion of glucocorticoid therapy, the patient remained hyperglycemic and was discharged home on standing insulin. Discussion: This case is an uncommon presentation of insulinoma in an elderly patient as insulinomas tend to peak at age 60 in women and at age 50 in men, and shows that in patients with significant comorbidities that preclude surgical intervention as the first-line treatment, EUS-RFA is a safe alternative option. In a recent study by Crino et al., it was found that EUS-RFA was safer than surgery and still highly effective in the treatment of small indolent insulinomas. The long half-life of diazoxide, acute kidney injury leading to decreased diazoxide clearance, and concomitant steroid-induced hyperglycemia may have contributed to the persistent hyperglycemia following RFA and resolution of the insulinoma. Conclusion: This case demonstrates the efficacy of EUS-RFA to treat insulinomas when surgery is contraindicated. Presentation: Sunday, July 13, 2025
Authors: April Alcantara, Melissa Trieu, Alyssa L Dominguez
Language: English
Subfield: Epidemiology
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,255
OpenAlex ID: W4415450889
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