Glucagonoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Pathophysiology

• A glucagonoma is a rare tumor of the alpha cells of the pancreas that results in the overproduction of the hormone glucagon. Alpha cell tumors are commonly associated with glucagonoma syndrome, though similar symptoms are present in cases of pseudoglucagonoma syndrome in the absence of a glucagon-secreting tumor.
• The primary physiological effect of glucagonoma is an overproduction of the peptide hormone glucagon, which enhances blood glucose levels through the activation of catabolic processes including gluconeogenesis and lipolysis. Gluconeogenesis produces glucose from protein and amino acid materials; lipolysis is the breakdown of fat.
• Diabetes mellitus also frequently results from the insulin and glucagon imbalance that occurs in glucagonoma.
• Pathogenesis of necrolytic migratory erythema is ill defined. Postulated mechanism for necrolytic migratory erythema involves combined effect of hyperglucagonemia, zinc deficiency, fatty acid deficiency, hypoaminoacidemia, and liver disease, that leads to excessive inflammation in the epidermis in response to trauma and to the necrolysis observed in necrolytic migratory erythema.

Microscopic Pathology

On microscopic histopathological analysis, findings of glucagonoma are:

• Epidermal necrosis

• Subcorneal pustules, either isolated or associated with necrosis of the epidermis

• Confluent parakeratosis

• Epidermal hyperplasia, and marked papillary dermal angioplasia

• Suppurative folliculitis

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  Confluent epidermal necrosis(high mag)

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  Confluent epidermal necrosis(very high mag)

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  Confluent epidermal necrosis(intermed mag)

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  Confluent epidermal necrosis(low mag)

References

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