Veterinary Society of
Surgical Oncology

Clinical Features

Superficial Necrolytic Dermatitis

  • glucagonoma is a rare endocrine tumor of the α pancreatic cells and has been reported in 8 dogs
  • glucagonoma is associated with a characteristic dermatitis of the footpads = superficial necrolytic dermatitis
  • synonyms: metabolic epidermal necrosis, necrolytic migratory erythema, and diabetic dermatitis
  • skin lesions can also occur on the muzzle, mucocutaneous junctions, elbow, hocks, pinnae, and external genitalia
  • skin lesions tend to wax and wane and can be pruritic with secondary bacterial infections
  • however, superficial necrolytic dermatitis is not pathognomonic for glucagonoma as 78 cases of superficial necrolytic dermatitis have been reported and only 7 of these were diagnosed with concurrent glucagonoma
  • classification scheme has been proposed: superficial necrolytic dermatitis, superficial necrolytic dermatitis and hepatocutaneous syndrome, and suspected superficial necrolytic dermatitis, with glucagonoma reported in:
  • 9% of dogs with superficial necrolytic dermatitis
  • 60% of dogs with superficial necrolytic dermatitis and hepatocutaneous syndrome
  • 31% of dogs with suspected superficial necrolytic dermatitis
  • superficial necrolytic dermatitis resolves following successful surgical resection of the pancreatic glucagonoma
  • DDx: pemphigus foliaceus, SLE, generic dog food dermatosis, and zinc-responsive dermatosis

From: Withrow SJ & MacEwen EG (eds): Small Animal Clinical Oncology (3rd ed).

Diabetes Mellitus

  • glucagon promotes gluconeogenesis and glycogenolysis
  • hyperglycemia will result if there is an excess of glucagon relative to insulin
  • diabetes mellitus will occur if insulin production cannot match the excessive secretion of glucagon

Other Clinical Signs

  • other clinical signs include weight loss, polyuria, and polydipsia
  • weight loss is caused by the catabolic effects of glucagon on fat and protein metabolism

Diagnosis

  • hematologic and serum biochemical abnormalities include non-regenerative anemia and elevated liver enzymes ± hypoalbuminemia, decreased BUN, and persistent hyperglycemia
  • skin biopsy: diffuse parakeratotic hyperkeratosis with high levels of confluent vacuolation of keratinocytes resulting in epidermal edema, with minimal dermal changes (i.e., perivascular accumulation of lymphocytes and plasma cells)
  • chronic lesions may have superficial to lichenoid inflammatory infiltrates
  • abdominal and thoracic imaging for detection of a pancreatic mass and metastatic disease
  • however, pancreatic mass was only detected in 13% (1/8) dogs with ultrasonographic examination
  • multiple diffuse hypoechogenic foci in the liver (= honeycomb pattern) is present in 50% (4/8) dogs with glucagonoma and is consistent with hepatic metastases
  • plasma glucagon levels in the absence of hypoglycemia strongly supports the diagnosis of glucagonoma

Treatment

  • exploratory celiotomy with partial pancreatectomy and clinical staging for metastatic disease
  • tumor debulking can decrease the intensity of skin lesions in humans with glucagonoma
  • octreotide is recommended for medical management of humans with glucagonoma
  • other medical treatment options include decarbazine and streptozotocin with 5-fluoroucil

Prognosis

  • prognosis is poor with metastasis common and widespread at diagnosis
  • survival times range from 3 days to 9 months

PANCREATIC GLUCAGONOMA

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