Zhan Shi-Ping
Department of Dermatology, General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan 430000, Hubei Province, China.
World J Clin Cases. 2024 Aug 16;12(23):5404-5409. doi: 10.12998/wjcc.v12.i23.5404.
With the incidence of pancreatic diseases increasing year by year, pancreatic hyperglycemia, as one of the common complications, is gradually gaining attention for its impact on the skin health of patients.
This was the case of an elderly female with clinical manifestations of necrolytic migratory erythema, "three more and one less," diabetes mellitus, hypertension, anemia, hypoproteinemia, and other syndromes, which had been misdiagnosed as eczema. Abdominal computed tomography showed a pancreatic caudal space-occupying lesion, and the magnetic resonance scanning of the epigastric region with dynamic enhancement and diffusion-weighted imaging suggested a tumor of the pancreatic tail, which was considered to be a neuroendocrine tumor or cystadenoma. The patient was referred to a more equipped hospital for laparoscopic pancreatic tail resection. Post-surgery diagnosis revealed a neuroendocrine tumor in the tail of the pancreas. To date, the patient's general condition is good, and she is still under close follow-up.
Necrolytic migratory erythema can be induced by endocrine system tumors or endocrine metabolic abnormalities, with complex clinical manifestations, difficult diagnosis, and easy misdiagnosis by dermatologists. The initial treatment principles in dermatology include symptomatic supportive therapy and effective drugs to relieve skin lesions. After clarifying the etiology of glucagonoma, comprehensive treatment in collaboration with endocrinologists, general surgeons, and oncologists can help provide individualized treatment for patients and improve their prognosis.
随着胰腺疾病的发病率逐年上升,胰腺性高血糖作为常见并发症之一,因其对患者皮肤健康的影响而逐渐受到关注。
该病例为一名老年女性,有坏死性游走性红斑、“三多一少”、糖尿病、高血压、贫血、低蛋白血症等综合征的临床表现,曾被误诊为湿疹。腹部计算机断层扫描显示胰尾占位性病变,上腹部磁共振扫描动态增强及弥散加权成像提示胰尾肿瘤,考虑为神经内分泌肿瘤或囊腺瘤。患者被转至设备更齐全的医院行腹腔镜胰尾切除术。术后诊断为胰腺尾部神经内分泌肿瘤。迄今为止,患者一般情况良好,仍在密切随访中。
坏死性游走性红斑可由内分泌系统肿瘤或内分泌代谢异常诱发,临床表现复杂,诊断困难,皮肤科医生易误诊。皮肤科的初始治疗原则包括对症支持治疗及有效缓解皮肤损害的药物。明确胰高血糖素瘤的病因后,与内分泌科医生、普通外科医生及肿瘤科医生合作进行综合治疗,有助于为患者提供个体化治疗并改善其预后。