Endocrine Abstracts (2010) 22 P379

No secreting multiple glucagonoma: one case

Jean Paul Ory & Simona Barbat


CHI, Vesoul Haute Saone, France.


Glucagonoma is an exceptional tumor but malignant in 80% of cases. Characteristic signs (migrating necrotic erythema, loss of weight) are connected with glucagon secretion, therefore variable. In this case report, the connection with pre-existent diabetes seems fortuitous.

Case report: Mr L, 60 years old, sent in November 2007 for type 2 diabetes 15 years old, unbalanced (HbA1C: 13%), treated by metformin and sulfonylurea, neglected. There is a polyneuropathy, an arterial hypertention, a renal failure (creatinine clearance: 60 ml/min) with proteinuria (500 mg/24 h). After discussion, insulinization (Premix 2/day) is accepted by patient.

Four months later, HbA1C is at 6.8%. Three months later, the HbA1C is stable without hypoglycaemia but the proteinuria has worsened at 2 g/24 h. The established fact of a lipasaemia at 80 u justifies the abdominal TDM: nodular formation of 1 cm in diameter on the anterior face of the pancreatic uncus. Echoendoscopy permits a biopsy of two identified lesions (8 and 2 mm): glucagonoma (confirmed by immunomarking) but malignancy is impossible to specify. The search for NEM-1 is negative. The positive octreoscan confirms the two localizations. Cephalic duodeno-pancreatectomy expanded to the body is executed. After effects are simple. Histologically, three tumours are discovered of 7.2 and 1 mm in diameter, without any sign of malignancy. This glucagonoma is no secreting, of quasi fortuitous discovery. The patient is now treated by basal/bolus insulinization and carefully looked after. A posteriori, was it necessary to operate this patient? Whithout strict proof of mildness of pancreatic tumour, our choice was justified.

Article tools

My recent searches

No recent searches.

My recently viewed abstracts