DISCUSSION

A provisional clinical diagnosis of glucagonoma was made on the basis of history, general physical examination and systemic examination findings. Patient’s routine investigations suggested anemia with elevated glucagon levels. CECT whole abdomen was suggestive of well-defined hyper-vascular mass in the tail of pancreas. Somatostatin receptor Scintigraphy suggested of increased focal uptake. A diagnosis of glucagonoma was made and patient was put on somatostatin analogues.

Glucagonoma is an extremely rare pancreatic α-islet cell tumor and is often accompanied by certain clinical symptoms including necrotizing migratory erythema (NME), diabetes, weight loss and anemia. The disease’s hallmark is Necrotic Migratory Erythema, weight loss and abdominal pain called glucagonoma triad. The diagnosis of glucagonoma involves a combination of clinical features, laboratory tests, and imaging. Clinically, glucagonoma presents with skin ulcerations, uncontrolled hyperglycemia, severe weight loss despite increased appetite, abdominal pai, neuropsychiatric manifestations (Depression, Psychosis). Elevated gucagon levels in plasma support diagnosis. CECT Whole abdomen, MRI Pancreas, Somatostatin receptor scintigraphy also helps in diagnosis. Early identification is crucial for initiating treatment and managing complications.

REFERENCES

1. Klimstra DS, Arnold R, Capella C, et al. Neuroendocrine neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of the digestive system. IARC Press; Lyon: 2010. pp. 322–326.