A Case of Multiple Liver Metastases of Glucagonoma Detected by Diabetic Ketosis

Abstract

We herein report a 57-year-old man with glucagonoma who developed ketosis. He had visited our clinic due to thirst, general fatigue, and weight loss for the past two months. His body mass index was 20.3 kg/m² at the time of his visit. He was diagnosed with diabetic ketosis based on the following findings: blood glucose, 454 mg/dL; HbA1c, 14.1 %; and positive urine ketone bodies, and he was treated with insulin therapy. Computed tomography revealed multiple tumors in the pancreatic tail and liver. His fasting glucagon level of 442 pg/mL on a blood test suggested he had glucagonoma. He was treated with everolimus but developed interstitial pneumonia 15 months later and stopped treatment. After that, streptozocin was started, but it was stopped due to deterioration of the renal function. He underwent distal pancreatectomy at another hospital. The pathological diagnosis was pancreatic neuroendocrine tumor G1, with positive glucagon staining. With regard to diabetes, insulin was able to be withdrawn after discharge, and he was treated with an oral hypoglycemic agent. However, insulin was resumed two months before the onset of interstitial pneumonia and was able to be withdrawn again after surgery. The presence of secondary diabetes should also be borne in mind when diagnosing diabetes.