gastrointestinal disorders
Glucagonoma
Treatment of Glucagonoma
Surgical resection for localized disease Chemotherapy for metastatic disease Octreotideto suppressglucagonproduction Resection of the tumor alleviates all symptoms. Unresectable, metastatic, or recurrent tumors are treated with combinationstreptozocinanddoxorubicin, which may decrease levels of circulating immunoreactiveglucagon, lessen symptoms, and improve response rates (50%) but are unlikely to improve survival. Newer chemotherapies under investigation for glucagonoma includetemozolomide-based regimens,everolimus, orsunitinib. Octreotideinjections partially suppressglucagonproduction and relieve the erythema, but glucose tolerance may also decrease becauseoctreotidedecreasesinsulinsecretion.Octreotidemay quickly reverse anorexia and weight loss caused by the catabolic effect ofglucagonexcess. Patients who respond may be converted to a long-actingoctreotideformulation given 20 to 30 mg IM once a month. Patients usingoctreotidemay also need to take supplemental pancreatic enzymes becauseoctreotidesuppresses pancreatic enzyme secretion. Locally applied, oral, or parenteral zinc may cause the erythema to disappear, but resolution may occur after simple hydration or IV administration of amino or fatty acids, suggesting that the erythema is not solely caused by zinc deficiency. 