Duodenal neuroendocrine tumor and the onset of severe diabetes mellitus in a US veteran

Abstract

Objective:Neuroendocrine tumors are neoplasms derived from endocrine cells, most commonly occurring in the gastrointestinal tract. Duodenal neuroendocrine tumors are rare tumors averaging 1.2–1.5 cm, and most are asymptomatic. Common presentation is abdominal pain, upper gastrointestinal bleed, constipation, anemia, and jaundice.Methods:An adult, Black, male patient with newly diagnosed diabetes mellitus presented to the emergency department with elevated liver function test and fatigue.Results:Magnetic resonance cholangiopancreatography demonstrated a large obstructing mass (3.6 cm × 4.4 cm × 3 cm) within the second and third portions of the duodenum at the ampulla. Esophagogastroduodenoscopy demonstrated an ulcerated duodenal mass that was biopsied. Immunohistochemical stains were positive for synaptophysin, chromogranin B, and CK7. Chromogranin A was in normal range. Post-Whipple procedure demonstrated a 5.5 cm × 4.1 cm × 2.9 cm duodenal mass with invasion of the subserosal tissue of the small intestine, a mitotic rate of 2 per high-power field, and antigen Ki-67 of 2%–5%.Conclusion:This case raises the question as to if the patient developed diabetes mellitus due to the tumor size and location or if the new onset of diabetes was coincidental. This case also demonstrates the importance of a proficient history and physical.

Management of Gastrointestinal Neuroendocrine Tumors

“…23 Neuroendocrine tumors in the duodenum may also cause upper GI bleeding, jaundice, and/or duodenal obstruction with nausea/vomiting. 24 Neuroendocrine tumors of the colon are commonly diagnosed during evaluation for abdominal pain, anorexia, or weight loss. Typical symptoms of rectal NETs are change of bowel habit and bleeding and may masquerade as hemorrhoids.…”

Non-functional duodenal neuroendocrine carcinoma: a rare cause of diabetes mellitus

“…Murray et al . ( 6 ) in 2016 reported a similar case in a middle aged, black, North American male who presented with newly diagnosed diabetes and was found to have a non-functional d-NET obstructing the biliary and pancreatic ducts. There was persistence of diabetes following surgical removal.…”

Normalization of Prediabetic Hemoglobin A1c (HbA1c) Levels After the Surgical Removal of a Serotonin-Secreting Neuroendocrine Tumor

“…Although the idea that serotonin-secreting tumors could alter glucose metabolism has existed since the 1970s [ 3 , 4 ], there has been a scarcity of epidemiologic data about the frequency of this phenomenon. Connecting this metabolic disturbance to NETs causally may be very challenging as prediabetes is a much more common condition that may simply coexist with NETs without any pathophysiologic relationship [ 5 ]. We present the case of a 58-year-old female with prediabetes who had her hemoglobin A1c (HbA1c) normalized after surgical removal of serotonin-producing NET.…”