RESUMO
Tumor-induced hypoglycemia is a serious disorder most commonly caused by insulinoma or non-islet cell tumor hypoglycemia (NICTH). The hypoglycemia can be severe and refractory to conventional therapy, leading to significant morbidity and mortality. The objective of this work is to describe a series of challenging cases in which refractory, tumor-induced hypoglycemia was shown to respond to the use of pasireotide, a second-generation somatostatin receptor ligand. We describe the clinical and biochemical features of 3 patients with tumor-induced hypoglycemia due to an occult insulinoma, malignant insulinoma, and non-islet cell tumor hypoglycemia. In these 3 individuals, the hypoglycemia remained refractory to guideline-recommended medical therapy, such as diazoxide, nonpasireotide somatostatin analogues, and glucocorticoids. Pasireotide was substituted to attenuate the refractory hypoglycemia for each patient. The addition of pasireotide led to prompt improvement in the frequency and severity of hypoglycemic episodes for each tumor-induced hypoglycemia patient. We demonstrate the successful treatment of 3 individuals with refractory, tumor-induced hypoglycemia with pasireotide. We offer the first reported use of pasireotide for the successful treatment of nonmalignant insulinoma and non-islet cell tumor hypoglycemia.
RESUMO
The high demands of contemporary medical practice have minimized the patient-physician contact with less or no time for Empathy. Unconsciously, our mind is set to focus on "disease" and often patients are referred as "cases." Where there is a rising concern of physician fatigue and burn out, there is equal concern of losing the component of "being humane" in the busy era of modern medical practices. The inability to connect with the patients has increased physician's susceptibility to burn out and dissatisfaction on the part of patient and physician.We propose Empathy based innovative concept "EASE" that envision patient-centered approach instead of disease-centered approach to ensure healthcare delivery in a humane, meaningful way to foster patient-physician relation. High Empathy is associated with low physician burnout and is a key driver for patient satisfaction. Health is defined as a state of complete physical, mental, and social wellbeing and not merely the absence of disease. EASE based approach is a sequential, comprehensive approach that encompasses all elements of human health to be incorporated in patient's encounter in the order:E Empathy & Emergent careA AilmentS Supportive Care & Social needsE Emotional wellbeing & Patient Education.
