Endocrine Abstracts

JOINT1629

Introduction: Pancreatic cancer is the fourth leading cause of cancer death in the United States and the fifth leading cause of cancer death in Europe. It has a dismal five-year survival of 5%, primarily related to the fact that disease-specific symptoms occur late in the course of the disease; at the time of diagnosis, 50% have distant metastases, 29% have local and/or regional spread, and only 3% have tumors confined to the pancreas (19% remain unstaged/unknown). By the time of diagnosis <15% of patients have surgically resectable disease. The median survival of unresectable pancreatic cancer is 4–6 months. While the overall 5-year survival of resected pancreatic cancers (median size 32 mm) is 10–20%, it is 30–60% after resection of small pancreatic cancer (tumor size ≤20 mm) and it exceeds 75% when minute pancreatic cancers (≤10 mm in size) are resected. While future treatment advances may improve survival, the above noted statistics imply that, in order to substantially impact long-term survival, we will need to detect pancreatic cancer earlier.

Case report: We present a case of a 69-year-old women with strong family history of diabetes. Previous laboratory tests revealed negative anti-pancreatic antibodies and diagnosis of type 2 diabetes was considered. The patient was treated by metformin and gliclazide continued to loose weight. Considering high suspicion for type 1 diabetes patient was switched to basal-bolus insulin therapy. Patient had unmanaged glucose values and insulin regimen was adjusted according to our recommendations. 2 years after initial diagnosis of diabetes patient was evaluated by internal medicine specialist due to new onset of jaundice. Locally advanced Pancreatic adenocarcinoma was diagnosed and corresponding treatment was initiated.

Conclusion: Patients with pancreatic cancer often have new-onset diabetes which resolves with cancer resection. New-onset diabetes not only defines a high-risk group for pancreatic cancer but is also a marker of early, asymptomatic cancer. Its occurrence in nearly half the patients with pancreatic cancer makes it an attractive screening target for early pancreatic cancer. This observation argues among several mechanisms explaining diabetes in subjects with pancreatic cancer, in favor of tumor-derived diabetogenic substance and suggests that diabetes mellitus could reveal pancreatic cancer even in the presence of conventional risk factors of type 2 diabetes.