Insulinoma Treatments
Treating an insulinoma
Surgery and ablation
Surgery is the preferred treatment for a localised insulinoma and can provide a cure. The operation depends on the tumour’s position and its distance from the pancreatic duct. [3]
Selected patients with a small localised insulinoma who are unsuitable for surgery may be offered endoscopic ultrasound guided radiofrequency ablation, which destroys the tumour with heat. Longer term evidence remains limited. [3]
Controlling low blood glucose
Regular meals and snacks containing slowly absorbed carbohydrates help prevent hypoglycaemia. Diazoxide reduces insulin release, but needs monitoring for side effects, including fluid retention. Continuous glucose monitoring can help identify low blood glucose, especially overnight. [3]
Somatostatin analogues, including octreotide and lanreotide, can help some patients. They can also worsen hypoglycaemia, so a closely monitored trial of short acting octreotide is recommended before longer acting treatment. [3]
Watchful waiting alone is inappropriate for an insulinoma causing hypoglycaemia. [1]
Treatment for advanced disease
When disease has spread or cannot be removed, the NET team selects treatment according to tumour growth, grade, scan findings, previous treatment and overall health. Options include: [2]
Everolimus: a targeted medicine that blocks signals involved in tumour growth. [2] It can also help control persistent hypoglycaemia. [1]
Sunitinib: a targeted medicine that interferes with signals supporting tumour blood vessel growth. [2]
Peptide receptor radionuclide therapy (PRRT): lutetium-177 DOTATATE delivers radiation to tumours with suitable somatostatin receptors, assessed using receptor imaging. [2] It may also improve hypoglycaemia. [1]
Chemotherapy: options include capecitabine with temozolomide, or streptozotocin combinations. It may be selected when tumour shrinkage is needed. [2]
Treatment aimed at liver deposits: selected patients may benefit from surgery, heat ablation, or treatments through the liver’s arteries, including embolisation, chemoembolisation and radioembolisation (SIRT). These require specialist multidisciplinary assessment. [1]
Clinical Trials
Clinical trials are medical research trials involving patients. They are carried out to try to find new and better treatments. Carrying out clinical trials is the only sure way to find out if a new approach to cancer care is better than the standard treatments currently available can find out more about A Phase 3 Study of Ersodetug in Patients With Tumor Hyperinsulinism (Tumor HI)
Follow up
After complete removal: for a localised insulinoma with no signs of malignancy and no grade 3 disease, ENETS recommends one review after 3 to 6 months. If symptoms have resolved, further routine tumour follow up is not required. Your NET team should confirm whether this recommendation applies to you. [1]
Other cases: follow up is individualised according to tumour grade, extent, growth, treatment and symptoms. Seek medical attention promptly if symptoms of low blood glucose return. [1]
Sources
1. Main source: ENETS 2023, Questions 6, 8 and 9.
Hofland J, Falconi M, Christ E, et al. European Neuroendocrine Tumor Society 2023 guidance paper for functioning pancreatic neuroendocrine tumour syndromes. Journal of Neuroendocrinology. 2023;35(8):e13318.
https://doi.org/10.1111/jne.13318
2. Companion ENETS 2023 guidance for tumour treatments, referenced by the functioning syndromes paper.
Kos-Kudła B, Castaño JP, Denecke T, et al. European Neuroendocrine Tumour Society (ENETS) 2023 guidance paper for nonfunctioning pancreatic neuroendocrine tumours. Journal of Neuroendocrinology. 2023;35(12):e13343.
https://doi.org/10.1111/jne.13343
3. Supplementary explanation of insulinoma treatments.
Hofland J, Refardt JC, Feelders RA, Christ E, de Herder WW. Approach to the Patient: Insulinoma. The Journal of Clinical Endocrinology & Metabolism. 2024;109(4):1109–1118.
https://doi.org/10.1210/clinem/dgad641
Treatment and follow up information updated: 27 September 2026.