Long-Term Effect of 177Lu-Dotatate on Severe and Refractory Hypoglycemia Associated with Malignant Insulinoma

ABSTRACT Objective Malignant insulinoma is an extremely uncommon tumor that is usually accompanied by severe hypoglycemia that is difficult to manage. At this time, the long-term effect of 177Lu-DOTATATE (lutetium [Lu-177]-DOTA-Tyr3-octreotate) on this tumor is not well known. Methods We report a case of severe, life-threatening, and refractory hypoglycemia associated with malignant insulinoma treated with 177Lu-DOTATATE. Results A 51-year-old woman was referred because of severe, life-threatening, and refractory hypoglycemia due to malignant insulinoma. The patient had been treated unsuccessfully with chemotherapy, targeted therapies, and symptomatic therapy with diazoxide, steroids, and somatostatin analogues without success. 177Lu-DOTATATE adequately controlled her hypoglycemia after the other conventional treatments failed. Conclusion 177Lu-DOTATATE was effective in providing rapid and long-term symptomatic control of the hypoglycemia and significantly improved the quality of life of the patient.