The 514th case: urinary stone excretion, elevated blood glucose, pancreatic mass,and co-secretion of multiple hormones
10.3760/cma.j.cn112138-20250630-00378
- VernacularTitle:第514例——尿中排石、血糖升高、胰腺占位、多种激素共分泌
- Author:
Yiran ZHANG
1
;
Zhixiang WANG
;
Yan JIANG
;
Wenjing LIU
;
Runing ZHOU
;
Yue CHI
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院内分泌科，北京 100730
- Publication Type:Journal Article
- Keywords:
Glucagonoma;
Hyperparathyroidism, primary;
Hypercalcitoninemia;
Multiple endocrine neoplasia type 1
- From:
Chinese Journal of Internal Medicine
2025;64(12):1248-1254
- CountryChina
- Language:Chinese
-
Abstract:
A 44-year-old male presented with a 19-year history of urinary calculi and a 1-year history of polydipsia and weight loss. Laboratory tests revealed hyperparathyroidism and evidence of glucagonoma-associated diabetes. Imaging studies identified masses in the pancreatic head and body/tail, suggestive of glucagonoma and a parathyroid adenoma. Furthermore, the patient exhibited hypercalcitoninemia and elevated cortisol and adrenocorticotropic hormone levels. Genetic testing revealed a heterozygous MEN1 mutation [c.65T>G (p.Leu22Arg)], confirming the diagnosis of multiple endocrine neoplasia type 1 (MEN-1). The patient subsequently underwent near-total parathyroidectomy and total pancreatectomy. Postoperative immunohistochemical staining of the pancreatic tail tumor was positive for glucagon and calcitonin. The patient′s postoperative hormone levels (calcitonin, glucagon, adrenocorticotropic hormone, cortisol) normalized, suggesting a rare pancreatic neuroendocrine tumor (pNET) that was co-secreting multiple hormones. Postoperative management included pancreatic enzyme supplementation, calcium supplementation, vitamin D supplementation, and insulin for glycemic control. Follow-up evaluations at 10 months demonstrated a stable clinical condition, well-controlled blood glucose and biochemical parameters, and an acceptable quality of life. This case study highlights that the presence of pNETs should be considered in patients with MEN-1 and multiple abnormal hormone levels. Timely surgical management of the involved glands and postoperative complications can effectively improve prognosis.
