Accurate localization of an insulinoma by preoperative selective intra-arterial calcium injection and intraoperative glucose monitoring. TI - A particularly aggressive combined glucagonoma and gastrinoma syndrome. Duodeno-pancreatic biochemically polyfunctional endocrine tumour is a well known entity. Usually, only one hormone is responsible for the clinical features. We report a case of aggressive combined glucagonoma and gastrinoma tumour without metastases, causing respectively diabetic ketoacidosis and fulminant peptic ulcer, and death.
Occasional patients can present with clinical features of both glucagonoma and gastrinoma.
Diabetic patients exhibiting migratory skin lesions should be suspected of glucagonoma. In addition, a multidisciplinary approach to such patients including dermatologists, surgeons, radiologists and endoscopists is mandatory. Sensitivity, specificity, and the best and minimum number of sequences for definitive diagnosis were determined. MR imaging accurately depicts small islet cell tumors. T2-weighted fast SE and spoiled GRE sequences usually suffice.