Endocrine Abstracts

Introduction

Pancreatic cancer is one of the cancers of the digestive tract for which the prognosis has not been improved in terms of early diagnosis. Recent diabetes can be indicative of this pathology.

Observation

A 56-year-old man with no notable pathological history who has presented for 04 months a deterioration in general condition with weight loss. On clinical examination: BMI: 17 kg/m². In biology: Venous glycemia: 32 mmol/l/l, HbA1c: 8.9%. Transaminases: normal, total bilirubin: 317 mmol/l (60N). GGT: 92 IU/l (5N), PAL: 537 IU/l, albuminemia normal, serum calcium. No degenerative complications of diabetes have been noted. An abdominal ultrasound revealed dilation of the intra and extra hepatic bile ducts without any detectable obstacle. Bili-MRI showed a poorly limited 17 × 18 mm pancreatic head mass responsible for dilation of the Wirsung’s duct with upstream parenchyma. The patient was put on insulin therapy and underwent a corporeal-caudal pancretectomy surgery followed by hormone therapy. The evolution was marked by glycemic instability with severe hypoglycaemia despite a drop in insulin-like doses of 0.1 u/kg. Is this an improvement in his diabetic pathology?

Conclusion

Diabetes can be concomitant with the diagnosis of pancreatic cancer in 40% or during the two years preceding the diagnosis of this neoplasia in 16% of cases. Diabetes can get better 57–89% of the time. Experimental studies have well established the diabetogenic effect of pancreatic neoplastic cells which are metabolically active. They alter carbohydrate metabolism, lowering the release of insulin.