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Metastatic Insulinoma with Long Survival and Glucagonoma Syndrome

CATHERINE M. D'ARCANGUES, M.D., Ph.D.; SISSAY AWOKE, M.D.; and GEORGE D. LAWRENCE, M.D.
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▸Requests for reprints should be addressed to George D. Lawrence, M.D.; St. Agnes Hospital, 900 Caton Avenue; Baltimore, MD 21229.


Baltimore, Maryland


© 1984 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1984;100(2):233-235. doi:10.7326/0003-4819-100-2-233
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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.

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