No secreting multiple glucagonoma: one case
Jean Paul Ory & Simona Barbat
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.