Endocrine Abstracts

Introduction: Glucagonomas are rare functioning pancreatic neuroendocrine tumours that secrete glucagon. Gastrinomas are neuroendocrine tumours that secrete gastrin and are rarely located in the stomach. We report an extremely rare case of concomitant gastric gastrinoma and glucagonoma.

Case presentation: A 64-year-old-man with a history of digestive haemorrhage and gastrectomy presented with weight loss, asthenia, anorexia and abdominal pain. Esophagogastroduodenoscopy revealed severe erosive gastritis on gastrectomy stump, biopsy confirmed a grade 1 neuroendocrine neoplasm. Computed Tomography (CT) scan showed a 70-mm solid mass of the lesser curvature of the gastric stump, multiple liver metastases, multiple coelio-mesenteric adenopathies and partial thrombosis of the spleno-mesenteric trunk. A positive octreoscan was diagnostic for neuroendocrine tumour. Serum gastrin level was 108 pmol/l (normal <60 pmol/l). Once the diagnosis of metastatic gastric gastrinoma was made, the patient was put on somatostatin analogues. At one-year follow up, the patient reported itching cutaneous eruptions in his groin area treated with topical steroids with no improvement. These skin lesions were associated with weight loss, anorexia, glossitis and newly discovered diabetes mellitus. On physical examination, the lesions were suggestive of necrolytic migratory erythema. Laboratory tests indicated elevated blood glucose (12 mmol/l) and anemia (11 g/dl). Fasting glucagon level was elevated (> 150 pmol/l, normal<60). Abdominal MRI showed a 10 mm peripheral nodule in the body of the pancreas.

Conclusion: The most interesting aspect of this case is the diagnosis of glucagonoma in a patient diagnosed with metastatic gastrinoma already treated with somatostatin analogues.