Somatostatin Analogs

Somatostatin analogs have been used for treatment of different types of endocrine tumors with considerable success.52 Octreotide acetate is an analog that has retained the active region of somatostatin but with certain modifications that make the derivative more resistant to peptidase degradation while increasing its biologic availability. Octreotide has been used to reduce hypoglycemic attacks in patients with unresectable insulinomas. A typical starting dose is 100 fig, given intravenously or subcutaneously every 8 hours. Doses may be increased to as high as 600 to 1500 fig per day.52 Long-acting somatostatin preparations, which may be administered on a monthly basis, are now also available.

Other Therapeutic Approaches

The effectiveness of chemotherapy against malignant insulinomas is limited at best. Regimens including streptozocin in combination with 5-fluorouracil and doxorubicin are usually employed.53 Hepatic artery chemoembolization has been tried with some success, as has operative debulking. Given the considerable morbidity of a hepatic resection in the setting of unresectable disease, radiofrequency ablation of hepatic metastases from a pancreatic insulinoma has been reported.54 This is a procedure that may be performed percutaneously in the outpatient setting in highly selected patients with limited hepatic metastases.

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