Glucagonoma medical therapy: Difference between revisions

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{{Glucagonoma}}
{{Glucagonoma}}
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{{CMG}}; {{AE}} {{PSD}}, {{MAD}}
==Overview==
==Overview==
The predominant medical therapy for primary glucagonoma is [[Somatostatin|somatostatin analogs]] ([[octreotide]]). Metastatic tumors need [[Therapeutic embolization|hepatic artery embolization]], [[radiofrequency ablation]], and molecular therapy.


==Medical Therapy==
== Management of Primary Tumor ==
* Heightened glucagon secretion can be treated with the administration of [[Somatostatin|octreotide, a somatostatin analog]], which inhibits the release of glucagon.<ref>{{cite journal |author=Moattari AR, Cho K, Vinik AI |title=Somatostatin analogue in treatment of coexisting glucagonoma and pancreatic pseudocyst: dissociation of responses |journal=Surgery |volume=108 |issue=3 |pages=581-7 |year=1990 |pmid=2168587 |doi=}}</ref>
* [[Somatostatin|Somatostatin analogs]] ([[octreotide]]) are the treatment of choice to control symptoms.<ref name="pmid25489112">{{cite journal| author=Rosenbaum A, Flourie B, Chagnon S, Blery M, Modigliani R| title=Octreotide (SMS 201-995) in the treatment of metastatic glucagonoma: report of one case and review of the literature. | journal=Digestion | year= 1989 | volume= 42 | issue= 2 | pages= 116-20 | pmid=2548911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2548911  }}</ref>
* [[Doxorubicin]] and [[streptozotocin]] have also been used successfully to selectively damage [[alpha cells]] of the pancreatic islets.
===Drug regimen===
Preferred regimen (1): [[Octreotide]] 400 micrograms/day


* [[Doxorubicin]] and [[streptozotocin]] have also been used successfully to selectively damage alpha cells of the pancreatic islets. These do not destroy the tumor, but help to minimize progression of symptoms.
== Metastasis Therapy ==
=== Hepatic artery embolization ===
*Hepatic arterial [[embolization]] is a palliative treatment in patients with symptomatic [[Hepatic metastasis|hepatic metastases]] who are not candidates for surgical resection.
*[[Therapeutic embolization|Embolization]] can be performed via the infusion through an [[Angiography|angiography catheter]] into [[Hepatic artery|hepatic arteries]].


* The only curative therapy for glucagonoma is [[surgery|surgical]] resection, where the tumor is removed. Resection has been known to reverse symptoms in some patients.
=== Radiofrequency ablation ===
*[[Ablation]] can be performed [[percutaneously]] or [[Laparoscopic surgery|laparoscopically]] in patients with symptomatic hepatic metastases who are not candidates for surgical resection.
*Ablation is applicable only to smaller lesions less than 3 cm.<ref name="pmid12967136">{{cite journal| author=Gupta S, Yao JC, Ahrar K, Wallace MJ, Morello FA, Madoff DC et al.| title=Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience. | journal=Cancer J | year= 2003 | volume= 9 | issue= 4 | pages= 261-7 | pmid=12967136 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12967136  }}</ref>
 
=== Molecular therapy ===
*[[Sunitinib]] is a radio-labeled [[somatostatin]] analog which has a role in the management of glucagonoma's that are not symptomatic or have rapidly progressive [[metastasis]].  


==References==
==References==
{{reflist|2}}
{{reflist|2}}
 
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Latest revision as of 01:48, 27 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2], Mohammed Abdelwahed M.D[3]

Overview

The predominant medical therapy for primary glucagonoma is somatostatin analogs (octreotide). Metastatic tumors need hepatic artery embolization, radiofrequency ablation, and molecular therapy.

Management of Primary Tumor

Drug regimen

Preferred regimen (1): Octreotide 400 micrograms/day

Metastasis Therapy

Hepatic artery embolization 

Radiofrequency ablation

  • Ablation can be performed percutaneously or laparoscopically in patients with symptomatic hepatic metastases who are not candidates for surgical resection.
  • Ablation is applicable only to smaller lesions less than 3 cm.[2]

Molecular therapy 

  • Sunitinib is a radio-labeled somatostatin analog which has a role in the management of glucagonoma's that are not symptomatic or have rapidly progressive metastasis.

References

  1. Rosenbaum A, Flourie B, Chagnon S, Blery M, Modigliani R (1989). "Octreotide (SMS 201-995) in the treatment of metastatic glucagonoma: report of one case and review of the literature". Digestion. 42 (2): 116–20. PMID 2548911.
  2. Gupta S, Yao JC, Ahrar K, Wallace MJ, Morello FA, Madoff DC; et al. (2003). "Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience". Cancer J. 9 (4): 261–7. PMID 12967136.

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