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Endocrine Abstracts (2023) 91 P40 | DOI: 10.1530/endoabs.91.P40

James Paget University Hospital, Gorleston, United Kingdom

73 year old lady with metastatic pancreatic cancer referred to diabetes clinic with worsening of her diabetes control. She was primarily under care of Gastroenterology department, for her symptoms of weight loss, abdominal pain, diarrhoea, sweating and anaemia. Her scan showed metastatic pancreatic cancer arising from tail of pancreatic with metastasis to liver. The liver biopsy of secondary liver deposit was not conclusive. She had borderline diabetes at her presentation worsened over 3 months from 51mmol/mol to 89 mmol/mol. She was started on oral hypoglycemia agents for few weeks with no improvement, she was then started on insulin therapy. Her case was again discussed in HBMDT for further investigation where it was agreed she should undergo Endoscopic ultrasound biopsy and a neuroendocrine tumour work up was requested. Her Urinary Hydroxyindole Acetic Acid was raised on 2 consecutive occasions. Fasting gut hormone profile revealed chromogranin A and b raised to 306 pmol/l and 242pmol/l respectively. Serum glucagon raised to 243pmol/l. Endoscopic ultrasound for tissue confirmation showed Metastatic Well Differentiated neuro endocrine tumour tail of pancreas grade 2, Ki 67 of 7%. Hence diagnosis of metastatic Glucagonoma. Patient was advised to start on Lanreotide plus chemotherapy after discussion in neuroendocrine and oncology MDT. Patient refused treatment. Patient still follow up in diabetes clinic. She is unable to gain weight because of catabolic effect of glucagon despite discussions with dietetics. Glucagonomas are very rare tumours arising from alpha cells of pancreas 1,2. Most are solitary, but can be associated with Multiple endocrine neoplasia syndrome rarely. This case has unique presentation from very start, interesting twists to final diagnosis. She has few symptoms of Glucagonoma syndrome diabetes, diarrhoea, sweating, Anaemia and weight loss, but no skin rash. 1-Glucagonoma syndrome: A case report JISHU WEI,1,* SHIBO LIN,1,* CONG WANG,2 JUNLI WU,1 ZHUYIN QIAN,1 CUNCAI DAI,1 KUIRONG JIANG,1 and YI MIAO1 Author information Article notes Copyright and License information Disclaimer 2-Glucagonoma and Glucagonoma Syndrome: A Case Report with Review of Recent Advances in Management Ashraf Al-Faouri, 1, * Khaled Ajarma, 1 Samer Alghazawi, 1 Sura Al-Rawabdeh, 2 and Adnan Zayadeen 3

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