Glucagonoma — RACP Adult Medicine MCQ

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HardEndocrinology & DiabetesGlucagonomaRACP Adult Medicine

A 50-year-old man presents with weight loss, abdominal pain, and steatorrhoea. He has migratory necrolytic erythema on his legs and groin. His blood glucose is 18 mmol/L (new-onset diabetes). Serum glucagon is markedly elevated. CT shows a large pancreatic body mass. What is the diagnosis?

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Correct answer: E — Glucagonoma

The glucagonoma syndrome is characterised by the 4 Ds: Dermatitis (necrolytic migratory erythema – pathognomonic), Diabetes (new-onset), Deep vein thrombosis, and Depression. Diarrhoea/steatorrhoea and weight loss also occur. Necrolytic migratory erythema presents as erythematous, blistering plaques with crusting that migrate across the body, typically affecting the groin, perineum, and extremities. Serum glucagon >500 pg/mL is diagnostic (>1000 pg/mL is essentially pathognomonic). Treatment is surgical resection. Somatostatin analogues control symptoms.

Reference: eTG – 2025 – Endocrinology; NCCN – 2025 – Neuroendocrine Tumour Guidelines