Abstract
A 75 year-old man diagnosed to have a glucagonoma and as he was deemed unfit for curative surgery, was managed conservatively. Over the next 7 years as a result of increase in tumour size and development of hepatic metastases he became progressively more symptomatic and chemotherapy was administered for palliation. Six months later, he experienced several episodes of symptomatic hypoglycaemia, which persisted despite withdrawal of insulin therapy. Biochemical assessment confirmed spontaneous endogenous hyperinsulinaemia. Hypoglycaemic symptoms responded partially to somatostatin analogues although over the next few months he continued to deteriorate and 8 years after the initial diagnosis died of tumour-related cachexia. This patient presents an unusual scenario where a neuroendocrine tumour initially presented as a glucagonoma with subsequent change in the predominant hormone secretion to insulin. In view of its temporal association, we postulate that following chemotherapy; one cell type was more successfully reduced as compared to others, resulting in predominance of insulin secreting cells.
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