A 45-year-old woman presents with chronic diarrhoea, weight loss, and a skin rash characterised by erythematous migratory plaques on the face, perineum, and extremities with central crusting and superficial blistering. Her glucagon level is markedly elevated. What is the associated tumour?
- A Gastrinoma of the pancreatic head
- B VIPoma causing watery diarrhoea and hypokalaemia
- C Insulinoma causing hypoglycaemia-related skin changes
- D Glucagonoma (alpha-cell tumour of the pancreas) ✓
Explanation
Necrolytic migratory erythema (NME) is the pathognomonic rash of glucagonoma syndrome — it presents with waxing-and-waning erythematous plaques with central blistering/crusting and superficial erosion typically affecting the perineum, groin, and lower extremities. The '4D' syndrome of glucagonoma includes: Dermatitis (NME), Diabetes, Deep vein thrombosis, and Depression. Glucagon causes hyperglycaemia, hypoaminoacidaemia (amino acids consumed for gluconeogenesis), and the skin changes. VIPoma (Verner-Morrison syndrome) causes profuse watery diarrhoea, hypokalaemia, and achlorhydria. Gastrinoma causes peptic ulcer disease and diarrhoea from gastric acid hypersecretion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.