Abstract
Insulinoma is a rare neuroendocrine tumor of the pancreas arising from β-cells, leading to excessive insulin secretion and resultant hypoglycaemia. Surgical resection is the first-line treatment for insulinoma, but when surgery is not feasible, medical therapy is an important option. Calcium channel blockers (CCBs) such as verapamil can inhibit insulin release from β-cells and have been proposed as an adjunct therapy to help control blood glucose levels in insulinoma. We report a 43-year-old man who presented to the emergency department with decreased consciousness due to hypoglycaemia. His capillary blood glucose at home was 35 mg/dL, about 8 hours after his last meal. He had a history of recurring hypoglycaemic episodes in the past month, with recorded blood glucose ranging from 26–100 mg/dL during a prior hospitalization. On examination, he was hemodynamically stable but had mild epigastric tenderness. Laboratory tests confirmed hyperinsulinemic hypoglycaemia (plasma glucose 58 mg/dL with concurrent serum insulin 47 µIU/mL and C-peptide 13.1 ng/mL), consistent with insulinoma. Abdominal imaging revealed a heterogeneous pancreatic mass suspected as an insulinoma. Initial management included a continuous infusion of 10% dextrose (500 mL/24h) with IV boluses of 40% dextrose as needed for blood glucose <70 mg/dL. Despite this, the patient experienced recurrent hypoglycaemia, so octreotide 50 µg three times daily was added. Octreotide alone did not fully stabilize his blood glucose levels. On the 6th day of hospitalization, oral verapamil 80 mg once daily was initiated – chosen both to treat the patient’s concurrent hypertension and for its potential to suppress insulin release. Following the addition of verapamil, the patient’s blood glucose levels improved and remained above 100 mg/dL with markedly reduced hypoglycemic episodes. The patient subsequently underwent a debulking surgery of the pancreatic tumor. This case highlights the importance of controlling blood glucose in insulinoma patients and demonstrates that the addition of verapamil can stabilize blood glucose when used alongside standard medical therapy (such as octreotide). Verapamil may serve as a useful adjunct in the management of insulinoma-related hypoglycemia, especially in patients awaiting surgery or those who are not surgical candidates.
Bahasa Abstract
Insulinoma adalah tumor neuroendokrin pankreas yang jarang, berasal dari sel β, yang menyebabkan sekresi insulin berlebihan dan hipoglikemia. Reseksi tumor merupakan terapi utama insulinoma; namun, apabila operasi belum dapat dilakukan, terapi medikamentosa menjadi pilihan penting. Penghambat kanal kalsium (calcium channel blocker/CCB) seperti verapamil diketahui dapat menghambat pelepasan insulin dari sel β pankreas, sehingga berpotensi digunakan sebagai terapi adjuvan untuk membantu pengendalian kadar glukosa darah pada insulinoma. Seorang pria, 43 tahun, datang ke instalasi gawat darurat dengan penurunan kesadaran akibat hipoglikemia. Kadar glukosa darah sewaktu di rumah tercatat 35 mg/dL, sekitar 8 jam setelah makan terakhir. Pasien memiliki riwayat episode hipoglikemia berulang dalam satu bulan terakhir; glukosa darah sewaktu selama perawatan sebelumnya berkisar 26–100 mg/dL. Pada pemeriksaan fisik, tanda vital stabil dengan sedikit nyeri tekan di epigastrium. Pemeriksaan laboratorium mengonfirmasi hipoglikemia hiperinsulinemik (glukosa plasma 58 mg/dL dengan insulin serum 47 µIU/mL dan C-peptida 13,1 ng/mL), sesuai dengan diagnosis insulinoma. Hasil pemindaian abdomen menunjukkan massa heterogen di pankreas yang dicurigai sebagai insulinoma. Penatalaksanaan awal mencakup infus dextrose 10% sebanyak 500 mL/24 jam disertai bolus dextrose 40% 50 mL jika glukosa darah <70 mg/dL. Meskipun demikian, hipoglikemia berulang masih terjadi, sehingga octreotide 50 µg tiga kali sehari ditambahkan. Pemberian octreotide tunggal belum mampu mengendalikan fluktuasi glukosa darah secara adekuat. Pada hari ke-6 perawatan, verapamil oral 80 mg satu kali sehari diberikan – pemilihan verapamil didasarkan pada adanya hipertensi (>140/90 mmHg) pada pasien dan bukti bahwa CCB dapat menurunkan sekresi insulin. Setelah penambahan verapamil, kadar glukosa darah pasien membaik dan bertahan diatas 100 mg/dL dengan frekuensi hipoglikemia yang jauh berkurang. Pasien kemudian menjalani operasi debulking tumor pankreas. Laporan kasus ini menekankan pentingnya pengendalian glukosa darah pada pasien insulinoma dan menunjukkan bahwa penambahan verapamil dapat menstabilkan kadar glukosa darah bila digunakan bersama terapi medikamentosa standar (misalnya octreotide). Verapamil dapat dipertimbangkan sebagai terapi adjuvan dalam penatalaksanaan hipoglikemia pada insulinoma, terutama pada pasien yang menunda operasi atau tidak dapat dioperasi.
Kata Kunci: Hipoglikemia, insulinoma, penghambat kanal kalsium, verapamil
Recommended Citation
Nizam, Nadhira; Putra, Ryan Tresna; and Hasibuan, Anshari Saifuddin
(2025)
"Penghambat Kanal Kalsium sebagai Kontrol Glukosa Darah pada Insulinoma: Sebuah Laporan Kasus,"
Jurnal Penyakit Dalam Indonesia: Vol. 12:
Iss.
1, Article 8.
DOI: 10.7454/jpdi.v12i1.1453
Available at:
https://scholarhub.ui.ac.id/jpdi/vol12/iss1/8
Included in
Chemical Actions and Uses Commons, Endocrinology, Diabetes, and Metabolism Commons, Internal Medicine Commons, Medicinal and Pharmaceutical Chemistry Commons, Other Pharmacy and Pharmaceutical Sciences Commons
