Clinical Scenario

This protocol applies to patients with glucagonoma situated in the head of the pancreas where the disease is resectable and has not metastasised. The clinical priority is achieving control of blood glucose and resolving the hallmark glucagonoma symptoms — flushing, diarrhea, and dermatitis — while preparing the patient for definitive surgical management.

Treatment Approach

The approach follows a structured pre-operative and operative sequence. It begins with a somatostatin analogue for symptom and tumour control, alongside targeted management of hyperglycaemia prior to surgery. Given the recognised hypercoagulable state associated with glucagonoma, perioperative anticoagulation is part of the plan. Definitive treatment for a tumour in the pancreatic head involves surgical resection. The complete sequence, specific agents, and operative details are in the structured protocol.

References

For tumors in the pancreatic head, pancreatoduodenectomy with resection of the peripancreatic lymph nodes is recommended.
For symptom and/or tumor control, octreotide LAR 20–30 mg IM or lanreotide 120 mg SC every 4 weeks. Higher doses have been shown to be safe. For breakthrough symptoms, octreotide 100–250 mcg SC TID can be considered.
For patients with glucagonoma, treatment of hyperglycemia and diabetes is necessary, especially to control blood sugar level prior to surgery.
A hypercoagulable state has been reported in 10% to 33% of patients with glucagonoma. Therefore, perioperative anticoagulation can be considered because of the increased risk of pulmonary emboli.

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Treatment of Resectable, Non-Metastatic Glucagonoma Located in the Head of the Pancreas

Clinical Scenario

Treatment Approach

Clinical Goals

References