Clinical heterogeneity in pancreatic neuroendocrine tumors: A case series of eight patients and their outcomes

Mangam NB, Deb P, Nalla S, Devireddy S, Kumar BK, Sastry RA, Sudhakar P, Nayani T, Sunil GS

Pdf Page Numbers :- 35-41

Naga Bhagyasri Mangam^1,*, Prasun Deb¹, Smitha Nalla¹, Sandeep Devireddy¹, Kiran Kumar B¹, Sastry RA², Pushpalatha Sudhakar³, Thushara Nayani¹ and Satya Sunil G³

¹Department of Endocrinology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India

²Department of Surgical Gastroenterology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 500003, Telangana, India

³Department of Nuclear Medicine, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 500003, Telangana, India

*Corresponding author: Dr. Naga Bhagyasri Mangam, Department of Endocrinology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India. Email: nagabhagyasrimangam@gmail.com

Received 3 October 2025; Revised 19 November 2025; Accepted 26 November 2025; Published 10 December 2025

Citation: Mangam NB, Deb P, Nalla S, Devireddy S, Kumar BK, Sastry RA, Sudhakar P, Nayani T, Sunil GS. Clinical heterogeneity in pancreatic neuroendocrine tumors: A case series of eight patients and their outcomes. J Med Sci Res. 2026; 14(1):35-41. DOI: http://dx.doi.org/10.17727/JMSR.2026/14-7

Copyright: © 2026 Mangam NB et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Pancreatic neuroendocrine tumors (NETs) are rare neoplasms, accounting for less than 3% of all primary pancreatic tumors, with an annual incidence of ≤1 per 100,000 population. They may occur sporadically or in association with hereditary syndromes such as multiple endocrine neoplasia type 1 (MEN-1), neurofibromatosis type 1 (NF-1), tuberous sclerosis, or Von Hippel–Lindau syndrome. Clinically, NETs are categorized as functioning (F-NET) or non-functioning (NF-NET) based on hormone secretion and associated symptoms. We retrospectively analyzed eight patients with pancreatic NETs managed in the Department of Endocrinology. Four patients had functioning tumors (insulinomas), all presenting with symptomatic hypoglycaemia, confirmed by low plasma glucose with inappropriately elevated insulin and C-peptide levels. These patients underwent surgical or minimally invasive procedures, resulting in complete resolution of symptoms. The four non-functioning NET cases presented with features related to mass effect or metastasis, including two patients with underlying hereditary syndromes. Management included surgical resection and, in advanced cases, systemic therapies such as somatostatin analogues (octreotide LAR) and peptide receptor radionuclide therapy (PRRT). Clinical outcomes ranged from stable disease to progression-free intervals depending on tumor grade and stage. This case series highlights the clinical heterogeneity of pancreatic NETs and underscores the importance of multimodal imaging, histopathological grading, and individualized therapeutic strategies. While surgery remains curative for most insulinomas, advanced NF-NETs often require multimodal systemic management. Long-term surveillance is essential due to the potential for recurrence or disease progression.

Keywords: pancreatic NET; insulinoma; functioning NET; non-functioning NET; MEN-1; NF-1; octreotide LAR; PRRT