{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:47Z","timestamp":1784557007852,"version":"3.55.0"},"reference-count":14,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T00:00:00Z","timestamp":1534982400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,8,23]]},"abstract":"Summary<\/jats:title>\n A 40-year-old Caucasian female presented with hyperglycaemia, polyuria, polydipsia and weight loss of 6\u2009kg over a 1-month period. There was no personal or family history of malignancy or diabetes mellitus. On examination, she was jaundiced with pale mucous membranes and capillary glucose was 23.1\u2009mmol\/L. Initial investigations showed iron deficiency anaemia and obstructive pattern of liver function tests. HbA1c was diagnostic of diabetes mellitus at 79\u2009mmol\/mol. Malignancy was suspected and CT chest, abdomen and pelvis showed significant dilatation of intra- and extra-hepatic biliary tree including pancreatic duct, with periampullary 30\u2009mm mass lesion projecting into lumen of duodenum. Enlarged nodes were seen around the superior mesenteric artery. This was confirmed on MRI liver. Fasting gut hormones were normal except for a mildly elevated somatostatin level. Chromogranin A was elevated at 78\u2009pmol\/L with normal chromogranin B. Duodenoscopy and biopsy showed possible tubovillous adenoma with low-grade dysplasia, but subsequent endoscopic ultrasound and biopsy revealed a grade 1, well differentiated neuroendocrine tumour. The patient was started on insulin, transfused to Hb >8\u2009g\/dL and Whipple\u2019s pancreatico-duodenectomy was undertaken. This showed a well-differentiated neuroendocrine carcinoma arising in duodenum (Grade G1 with Ki67: 0.5%), with areas of chronic pancreatitis and preservation of pancreatic islet cells. There was complete resolution of diabetes post Whipple\u2019s procedure and patient was able to come of insulin treatment. Her last HBA1C was 31\u2009mmol\/mol, 4 months post tumour resection.<\/jats:p>\n \n Learning points:<\/jats:title>\n \n \n Diabetes mellitus and malignancy can be related.<\/jats:p>\n <\/jats:list-item>\n \n A high index of suspicion is needed when diabetes mellitus presents atypically.<\/jats:p>\n <\/jats:list-item>\n \n Non-functional neuroendocrine tumours can present with diabetes mellitus.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-18-0061","type":"journal-article","created":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T09:27:05Z","timestamp":1535016425000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Non-functional duodenal neuroendocrine carcinoma: a rare cause of diabetes mellitus"],"prefix":"10.1530","volume":"2018","author":[{"given":"Chad","family":"Bisambar","sequence":"first","affiliation":[{"name":"1NHS Ayrshire and Arran, Ayr, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Collier","sequence":"additional","affiliation":[{"name":"1NHS Ayrshire and Arran, Ayr, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fraser","family":"Duthie","sequence":"additional","affiliation":[{"name":"2NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carron","family":"Meney","sequence":"additional","affiliation":[{"name":"1NHS Ayrshire and Arran, Ayr, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref31","doi-asserted-by":"crossref","first-page":"656","DOI":"10.5946\/ce.2013.46.6.656","article-title":"Endoscopic treatment of duodenal neuroendocrine tumors","volume":"46","year":"2013","journal-title":"Clinical Endoscopy"},{"key":"ref121","first-page":"1","article-title":"Duodenal neuroendocrine tumor and the onset of severe diabetes mellitus in a US 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