title: Malign cystic glucagonoma presented with diabetic ketoacidosis: case report with an update.
abstract: A 44-year-old woman was diagnosed with type II diabetes in 1998 and 1 year later she developed necrolytic migratory erythema, which is a specific skin lesion of glucagonoma. During the clinical investigation, a nodular 6 cm mass in the distal pancreatic region and multiple cystic liver metastases were found. She was operated on, and glucagonoma was detected and the long-acting, repeatable, octreotide treatment was started. 3 years after resection of a pancreatic glucagonoma she presented to a hospital emergency department with diabetic ketoacidosis. Hepatic multiple cystic metastases were visualized by computed tomography. During hospitalization she developed severe pulmonary embolism and deep-venous thrombosis of the lower extremities. Indium-labeled octeotide scintigraphy showed multiple cystic lesions in the liver with additional lesions in the iliocecal region, which had not been visualized by computed tomography. Despite somatostatin therapy the tumor had expanded in the liver. Arterial chemoembolization was performed but 6 months later she died.
authors.affiliation: Pamukkale University, School of Medicine, Departments of Endocrinology and Metabolism, Pamukkale University Hospital, Kinikli, Denizli, Turkey.
authors.forename: S M
authors.initials: SM
authors.lastname: Fenkci
authors.forename: G
authors.initials: G
authors.lastname: Fidan Yaylali
authors.forename: Y
authors.initials: Y
authors.lastname: Sermez
authors.forename: H
authors.initials: H
authors.lastname: Akdam
authors.forename: N
authors.initials: N
authors.lastname: Sabir
authors.forename: S
authors.initials: S
authors.lastname: Kiraç
mesh_terms: D000328:Adult; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000209:etiology; D004890:Erythema / Q000150:complications / Q000175:diagnosis; D005260:Female; D005935:Glucagonoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D011877:Radionuclide Imaging