Abstract
Somatostatinomas are rare gut neuroendocrine tumours. The classical ‘somatostatinoma syndrome’, secondary to the inhibitory action of somatostatin, comprises mild diabetes mellitus, gall bladder disease and diarrhoea with steatorrhoea. The diabetes is usually mild and not associated with major ketosis.
We describe a 72 year-old man who presented with severe metabolic upset (hyperglycaemia, ketonuria and acute renal failure). He had lost significant amount of weight and was found to have extensive liver metastases. Biopsy confirmed a carcinoid tumour and somatostatin levels were markedly elevated in keeping with a diagnosis of metastatic somatostatinoma (probably of pancreatic origin). Paradoxically, a somatostatin analogue (octreotide, Sandostatin LAR) effectively controlled his symptoms and although insulin-dependent his daily requirement was never higher than 16 units.
We speculate that his tumour secreted a spectrum of somatostatin-related peptides with a relatively greater inhibitory effect on the pancreatic secretion of insulin, compared to glucagon, and that this was responsible for the severe metabolic derangement at first presentation. Glycaemic status should always be assessed in patients with newly presenting carcinoid tumours.
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