GLP1 and glucagon co-secreting pancreatic neuroendocrine tumor presenting as hypoglycemia after gastric bypass

Endocrinology, Diabetes & Metabolism Case Reports

article

Marta Guimarães¹  Pedro Rodrigues¹  Sofia S Pereira¹  Mário Nora¹  Gil Gonçalves¹  Nicolai Wewer Albrechtsen¹  Bolette Hartmann¹  Jens Juul Holst¹  Mariana P Monteiro¹ 

[1] Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga

关键词: Adult;    Female;    White;    Portugal;    Pancreas;    Tumours and neoplasia;    Insulin;    Glucagon;    GLP1;    Somatostatin;    Neuroendocrine tumour;    Hypoglycemia;    Obesity;    Post-prandial hypoglycemia;    Sweating;    Syncope;    Ultrasound scan;    Octreotide scan;    Glucose (blood);    Insulin;    Histopathology;    Resection of tumour;    Surgery;    Unique/unexpected symptoms or presentations of a disease;    August;    2015;   

DOI  :  10.1530/EDM-15-0049

学科分类：血液学

来源: Bioscientifica Ltd.

【 摘 要 】

Post-prandial hypoglycemia is frequently found after bariatric surgery. Although rare, pancreatic neuroendocrine tumors(pNET), which occasionally are mixed hormone secreting, can lead to atypical clinical manifestations, including reactivehypoglycemia. Two years after gastric bypass surgery for the treatment of severe obesity, a 54-year-old female withprevious type 2 diabetes, developed post-prandial sweating, fainting and hypoglycemic episodes, which eventually led tothe finding by ultrasound of a 1.8-cm solid mass in the pancreatic head. The 72-h fast test and the plasma chromogranin Alevels were normal but octreotide scintigraphy showed a single focus of abnormal radiotracer uptake at the site of thenodule. There were no other clinical signs of hormone secreting pNET and gastrointestinal hormone measurements werenot performed. The patient underwent surgical enucleation with complete remission of the hypoglycemic episodes.Histopathology revealed a well-differentiated neuroendocrine carcinoma with low-grade malignancy with positivechromogranin A and glucagon immunostaining. An extract of the resected tumor contained a high concentration ofglucagon (26.707 pmol/g tissue), in addition to traces of GLP1 (471 pmol/g), insulin (139 pmol/g) and somatostatin(23 pmol/g). This is the first report of a GLP1 and glucagon co-secreting pNET presenting as hypoglycemia after gastricbypass surgery. Although pNET are rare, they should be considered in the differential diagnosis of the clinical approachto the post-bariatric surgery hypoglycemia patient.

【 授权许可】

CC BY-NC-ND