• Giuseppe Corrias, Natally Horvat, Serena Monti, Olca Basturk, Oscar Lin, Luca Saba, Lisa Bodei, Diane L Reidy, and Lorenzo Mannelli.
• Department of Radiology, Memorial Sloan Kettering Cancer Center, NY Department of Radiology, University of Cagliari, Cagliari, Italy Department of Radiology, Hospital Sírio-Libanês, São Paulo Department of Radiology, Universidade de São Paulo, São Paulo, SP, Brazil IRCCS SDN, Naples, Italy Department of Pathology Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
• Medicine (Baltimore). 2017 Dec 1; 96 (50): e9252e9252.

RationaleGlucagonoma is an uncommon disease but it has been associated with a pattern of symptoms defined as glucagonoma syndrome. These symptoms, if promptly recognized, could help to speed up the diagnosing process.Patient ConcernsWe report a case of a 68-year-old woman with a pancreatic glucagonoma. Her symptoms at the onset were typical of the glucagonoma syndrome.DiagnosesAfter a significant weight loss, she underwent a computer tomography scan of the abdomen, which showed a hypervascular lesion of the tail of the pancreas and hypervascular lesions of the liver. An ultrasound guided biopsy was performed and pathology was consistent with glucagonoma. Her blood glucagon levels were elevated.OutcomesShe was treated with chemotherapy and somatostatin analogs. After 4 years, the disease had a malignant transformation, and metastases suddenly started to grow up. She stopped being responsive to treatment and eventually passed away.LessonsDue to its rarity, clinical diagnosis is challenging and generally it comes after a long interval since the onset of symptoms. Awareness of physicians and dermatologists of the characteristic necrolytic migratory erythema, and of the other symptoms, often leads to early diagnosis.Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

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