A case of glucagonoma with skin lesions, anemia, and hypoaminoacidemia markedly improved by medical therapy

We report a rare case of glucagonoma in the elderly ameliorated by medical therapy, including anabolic steroid. A 74-year-old woman seen for necrolytic migratory erythema and diagnosed with glucagonoma due to hyperglucagonemia (13,000 pg/m/) and a pancreas-body tumor 3 cm in diameter also had multiple micrometastases to the liver, deep venous thrombosis, and pulmonary embolism. Her poor general condition of 16.9 kg/m2 BMI, 1.5 g/d/serum albumin, and 6.8 g/d/hemoglobin was improved by treatment with octreotide, which decreased plasma glucagon to 1,500 pg/m/and amino acid supplementation, which markedly improved necrolytic migratory erythema. To sufficiently improve hypoalbuminemia and anemia, we administered the anabolic steroid metenolone, which ameliorated hypoaminoacidemia, hypoalbuminemia, and anemia, with serum albumin rising to 2.3 g/d/and Hb to 8.5 g/d/. Insulin therapy was required to manage hyperglycemia associated with reduced endogenous insulin secretion.