Advanced Peptide Receptor Radionuclide Therapy to Overcome Refractory Hypoglycemic Insulinoma: A Case Report and Review of the Literature

We reported the case of a 42-year-old man with refractory hypoglycemia caused by an inoperable malignant insulinoma and multiple liver metastases. The patient initially received bi-weekly intramuscular injections of octreotide long-acting release and a daily oral dose of everolimus. Despite this treatment, hypoglycemia was only partially alleviated, and there were no changes in tumor size. As a next step, the patient underwent peptide receptor radionuclide therapy (PRRT) with lutetium-177 (177 Lu)-Dotatate as a salvage therapy. After four courses of PRRT, there was a noticeable regression of the liver masses, and the hypoglycemia resolved. In addition, the patient’s quality of life significantly improved, as he no longer required antihypoglycemic medication or had to endure frequent blood sugar testing.