CATHERINE M. D'ARCANGUES, M.D., Ph.D.; SISSAY AWOKE, M.D.; GEORGE D. LAWRENCE, M.D.
In 1966, during cholecystectomy for cholecystolithiasis, a 56-year-old man was found to have islet-cell carcinoma metastatic to the liver; his fasting serum glucose level was normal. In 1971, he developed peptic ulcer disease and symptoms of fasting hypoglycemia; inappropriate secretion of insulin was shown. His primary pancreatic tumor was removed in 1973. During the next 9 years, his liver metastases continued to grow and his fasting serum glucose level was maintained at 35 to 116 mg/dL with diazoxide and hydrochlorothiazide therapy. In 1982, he developed clinical evidence of the glucagonoma syndrome, with glucagon levels between 4000 and 11 000 pg/mL. Since then, his fasting serum glucose level has been maintained at 58 to 119 mg/dL without medication. This patient has survived 17 years with a malignant insulinoma and without islet-cell chemotherapy. His course shows that malignant insulinomas may secrete other peptide hormones that can induce various clinical syndromes.
D'ARCANGUES CM, AWOKE S, LAWRENCE GD. Metastatic Insulinoma with Long Survival and Glucagonoma Syndrome. Ann Intern Med. ;100:233–235. doi: 10.7326/0003-4819-100-2-233
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Published: Ann Intern Med. 1984;100(2):233-235.
DOI: 10.7326/0003-4819-100-2-233
Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology, Pancreatic Cancer, Pancreatic Disease.
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