eMedicine Specialties > Endocrinology > Multiple Endocrine Disease and Miscellaneous Endocrine Disease

Glucagonoma: Follow-up

Author: Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy
Coauthor(s): Laura Diomede, University of Bari School of Medicine, Italy; Mini R Abraham, MD, Consulting Staff, Saint Luke's Medical Group
Contributor Information and Disclosures

Updated: Nov 20, 2008

Follow-up

Further Inpatient Care

  • For inpatients, psychotherapeutic intervention may be very helpful when comorbid depression is present.

Further Outpatient Care

  • Psychotherapeutic intervention may be very helpful when comorbid depression is present.

Inpatient & Outpatient Medications

  • Because of severe weight loss, a period of total parenteral nutrition may be needed as part of the preoperative preparation for patients with glucagonoma. Antibiotics, steroids, amino acids, and zinc supplementation may improve severe skin rash. Octreotide is also useful to help improve the perioperative condition of these patients. Prophylaxis for venous thrombosis and the subcutaneous administration of low-dose heparin are mandatory treatments for all patients during the perioperative period.
  • In patients for whom surgery is not feasible, consider administering streptozotocin and doxorubicin or streptozotocin and 5-FU.
  • In patients with widespread metastases, consider hepatic artery catheterism for doxorubicin + cisplatin + mitomycin-C administration. Such treatment can determine colliquative necrosis and mass reduction in large number of patients. In addition, octreotide administration before, during, and after locoregional therapy may stop the crisis due to the massive release of glucagon.

Complications

  • The main complication of glucagonoma is hepatic metastasis or metastasis of the locoregional lymph nodes.

Prognosis

  • The prognosis for glucagonoma is poor. The rate of survival after 5 years is difficult to determine because of the small number of patients who develop the disease. One study, however, reported an average survival time of 3.7 years in a group of 12 patients and an average survival period of 4.9 years in another group, consisting of 9 patients.

Miscellaneous

Medicolegal Pitfalls

  • The main medicolegal problems related to the treatment of glucagonoma are the toxic effects of antiproliferative drugs and the consequences of surgical procedures. For this reason, always obtain an informed consent for any procedure or treatment, explaining all procedures and their possible complications.

Special Concerns

  • The skin changes observed in patients with glucagonoma usually improve with resection of the tumor.
 


More on Glucagonoma

Overview: Glucagonoma
Differential Diagnoses & Workup: Glucagonoma
Treatment & Medication: Glucagonoma
Follow-up: Glucagonoma
Multimedia: Glucagonoma
References
Further Reading
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References

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Keywords

glucagonoma, glucagon, glucagonoma syndrome, alpha-cell tumor, alpha-cell adenoma, alpha cell, alpha cells, alpha-2 cell, alpha-2 cells, diabetes, diabetes mellitus, diabetes mellitus type 2, pancreas, hyperglycemia, hyperglycemic, neuroendocrine, 4D syndrome, neuroendocrine tumor, islet cell, islet cells, islet cell pancreatic tumor, pancreatic tumor, pancreas tumor, insulin, insulinoma, glucagon overproduction, hypoaminoacidemia, weight loss, normochromic and normocytic anemia, necrolytic migratory erythema, NME, hyperglucagonemia, pancreas, octreotide, Sandostatin, peptide hormone, bioactive peptide, tumor of the pancreas, multiple endocrine neoplasia type1, MEN I, islet celltumor

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Contributor Information and Disclosures

Author

Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy
Disclosure: Nothing to disclose.

Coauthor(s)

Laura Diomede, University of Bari School of Medicine, Italy
Disclosure: Nothing to disclose.

Mini R Abraham, MD, Consulting Staff, Saint Luke's Medical Group
Mini R Abraham, MD is a member of the following medical societies: American Association of Clinical Endocrinologists and Endocrine Society
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Novo Nordisk Honoraria Speaking and teaching; Eli Lilly Honoraria Speaking and teaching

Medical Editor

Frederick H Ziel, MD, Associate Professor of Medicine, David Geffen School of Medicine at UCLA; Physician-In-Charge, Endocrinology/Diabetes Center, Director of Medical Education, Kaiser Permanente Woodland Hills; Chair of Endocrinology, Co-Chair of Diabetes Complete Care Program, Southern California Permanente Medical Group
Frederick H Ziel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society for Bone and Mineral Research, California Medical Association, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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