RADIOFREQUENCY ABLATION AS A PRIMARY THERAPY FOR BENIGN FUNCTIONING INSULINOMA

Abstract Objective Insulinomas are rare life-threatening Pancreatic neuroendocrine tumors. Surgical removal continues to be the treatment of choice, yet it is associated with considerable risk of morbidity. Here we describe our patient with insulinoma who was successfully treated with radiofrequency ablation. Methods The patient is a 56-year-old male with no history of diabetes mellitus. He presented with recurrent episodes of transient ischemic attacks and stroke over the last three years. Some changes in his behavior and memory were noticed by family members. During his hospital stay for the second transient ischemic attack, frequent hypoglycemia was documented which was asymptomatic. Insulinoma was confirmed biochemically. Radiological findings were also compatible with pancreatic neuroendocrine tumor. Treatment modalities have been explained to the patient. However, he strongly refused surgery. Meanwhile, he was admitted with a stroke and concurrent hypoglycemia again. In view of his refusal of the surgical treatment and due to his presentation with acute stroke and high-risk status for surgery, the option of radiofrequency ablation was decided. Results Radiofrequency ablation of the pancreatic tumor using 40.75 GY over fractions was carried out with a favorable outcome. The patient has achieved biochemical normalization and remained euglycemic during his follow up. CT -scan of the abdomen during follow-up showed a mild regression of the size of the tumor. Conclusion This report shows a treatment challenge which required the use of an alternative treatment option other than the standard of care. It highlights the evolving evidence of radiofrequency as a therapeutic modality for patients with insulinoma.