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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 1444

Computerised tomograpy scan shows a highly vascularised mass on the body of the pancreas. She also had a basal plasma glucagon concentration of 1100 pg/ml and serum zinc level of 97 μg/dl. Necrolytic migratory erythema (NME) is an uncommon condition sometimes associated with high plasma levels of circulating glucagon and other metabolic changes, and characterised by an islet alpha cell pancreatic tumour, NME, diabetes mellitus, weight loss, anaemia, stomatitis, thromboembolism, and gastrointestinal and neuropsychiatric disturbances. Glucagon itself is responsible for most of the observed signs and symptoms, and its induction of hypoaminoacidaemia is thought to lead to NME. Liver disease and fatty acid and zinc deficiency states may also contribute. Most patients are diagnosed too late but successful palliation of symptoms can usually be achieved with surgical and medical intervention. Glucagonomas express somatostatin receptors in more than 80% of cases. In-111 DTPA N-terminal D-phenylalanine (D-PHE1) octreotide for glucagonoma imaging may be most beneficial as an adjuvant to conventional imaging for tumour staging and therapeutic decision making. In the presence of metastatic disease, crioablation, chemoembolisation, and operative procedures in selected cases are under evaluation.

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