Glucagonoma differential diagnosis: Difference between revisions

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|Glucagonoma
|Glucagonoma
|A family history of predisposing genetic disorders such as [[multiple endocrine neoplasia type 1]]
|A family history of [[multiple endocrine neoplasia type 1]]
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* [[Necrolytic migratory erythema]] (NME) is a classical symptom observed in patients with glucagonoma and is present in 80% of cases. Associated NME is characterized by the spread of erythematous blisters and swelling across areas subject to greater friction and pressure, including the lower [[abdomen]], [[Buttock|buttocks]], [[perineum]], and [[groin]].<sup>[[Glucagonoma history and symptoms#cite note-pmid4793623-2|[2]]]</sup>
* [[Necrolytic migratory erythema]] characterized by the spread of erythematous blisters and swelling across areas subject to greater friction and pressure, including the lower [[abdomen]], [[Buttock|buttocks]], [[perineum]], and [[groin]].<sup>[[Glucagonoma history and symptoms#cite note-pmid4793623-2|[2]]]</sup>
* [[Weight loss]]<sup>[[Glucagonoma history and symptoms#cite note-pmid86066272-3|[3]]]</sup>
* [[Weight loss]]<sup>[[Glucagonoma history and symptoms#cite note-pmid86066272-3|[3]]]</sup>
* [[Glucose intolerance]]<sup>[[Glucagonoma history and symptoms#cite note-pmid6268399-4|[4]]]</sup>
* [[Glucose intolerance]]<sup>[[Glucagonoma history and symptoms#cite note-pmid6268399-4|[4]]]</sup>
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* [[Rash|Rash:]] Erythematous, ring shaped [[rash]] that blisters, erodes, and crusts over suggesting [[necrolytic migratory erythema]].
* [[Rash|Rash:]] Erythematous, ring shaped [[rash]] that blisters, erodes, and crusts over suggesting [[necrolytic migratory erythema]].
* Muscle [[atrophy]] may be present.
* Muscle [[atrophy]] may be present.
* Unilateral calf or thigh erythema, swelling, and erythema.
* Unilateral calf or thigh erythema, and swelling.
* Hyporeflexia may be present
* Hyporeflexia
* Unilateral/bilateral [[sensory loss]] in the upper/lower extremity may be present
* Unilateral/bilateral [[sensory loss]] in the upper/lower extremity  
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* '''Serum glucagon'''<sup>[[Glucagonoma laboratory tests#cite note-pmid15313692-1|[1]]]</sup>
* '''Serum glucagon'''<sup>[[Glucagonoma laboratory tests#cite note-pmid15313692-1|[1]]]</sup>
** Normal [[Glucagon|glucagon level]] is less than 50 pg/mL.
** Increased plasma glucagon levels (>500 pg/mL).<sup>[[Glucagonoma laboratory tests#cite note-pmid8606627-3|[3]]]</sup>
** Increased plasma glucagon levels (>500 pg/mL).<sup>[[Glucagonoma laboratory tests#cite note-pmid8606627-3|[3]]]</sup>
** Concentrations above 1000 pg/mL are diagnostic of glucagonoma.<sup>[[Glucagonoma laboratory tests#cite note-pmid17873310-4|[4]]]</sup>
** Concentrations above 1000 pg/mL are diagnostic of glucagonoma.<sup>[[Glucagonoma laboratory tests#cite note-pmid17873310-4|[4]]]</sup>


* CT scans are used to determine the location of the tumor, show the organs nearby, determining the stage of cancer and in determining whether surgery is a good treatment option.
* CT scans are used to determine the location of the tumor, show the organs nearby. Liver metastases may appear isodense with the liver on a non-contrasted study.<sup>[[Glucagonoma CT#cite note-pmid9574609-4|[4]]]</sup>
* Sensitivity is >80 percent but it is decreased for tumors smaller than 2 cm.<sup>[[Glucagonoma CT#cite note-pmid21067742-2|[2]]]</sup>
* Liver metastases may appear isodense with the liver on a non-contrasted study.<sup>[[Glucagonoma CT#cite note-pmid9574609-4|[4]]]</sup>
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|[[Liver cirrhosis|End-stage liver disease]]
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|[[Pemphigus foliaceus]] 
|[[Pemphigus foliaceus]] 
|It is an autoimmune blistering disease of the skin with characteristic lesions that are scaly, crusted erosions, often on an erythematous base.<sup>[[Pemphigus foliaceus#cite note-Fitz2-1|[1]]]</sup>
|Autoimmune blistering disease of the skin with characteristic lesions that are scaly, crusted erosions, often on an erythematous base.<sup>[[Pemphigus foliaceus#cite note-Fitz2-1|[1]]]</sup>


Mucosal involvement is absent even with widespread disease.<sup>[[Pemphigus foliaceus#cite note-Bolognia-2|[2]]]</sup>
Mucosal involvement is absent even with widespread disease.<sup>[[Pemphigus foliaceus#cite note-Bolognia-2|[2]]]</sup>


The pathway is most likely either of three mechanisms:
* Steric hindrance of the desmoglein 1: The antibody caps off the site for intracellular binding to another keratinocyte.
* Activation of an endocytic pathway: The antibody activates a pathway which causes an internalization of desmoglein 1, which in turn causes a loss of adhesion.
* Disruption of function: In this case, the antibody blocks the desmoglein 1 from being formed into a desmosome. This, in turn, causes a loss of adhesion with acantholysis as a result.
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* Pemphigus foliaceus is a superficial variant of pemphigus that presents with cutaneous lesions.
* The main symptom is a cutaneous lesion that usually develops in a seborrheic distribution:<ref name="pmid15993235">{{cite journal| author=Bystryn JC, Rudolph JL| title=Pemphigus. | journal=Lancet | year= 2005 | volume= 366 | issue= 9479 | pages= 61-73 | pmid=15993235 | doi=10.1016/S0140-6736(05)66829-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15993235  }}</ref>the scalp, face, and trunk are common sites of involvement.
* Pemphigus foliaceus usually develops in a seborrheic distribution.
 
<ref name="pmid15993235">{{cite journal| author=Bystryn JC, Rudolph JL| title=Pemphigus. | journal=Lancet | year= 2005 | volume= 366 | issue= 9479 | pages= 61-73 | pmid=15993235 | doi=10.1016/S0140-6736(05)66829-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15993235  }}</ref>
* The skin lesions may remain localized or may coalesce to cover large areas of skin.  
* The scalp, face, and trunk are common sites of involvement. The skin lesions usually consist of small, scattered superficial blisters that rapidly evolve into scaly, crusted erosions
* The skin lesions may remain localized or may coalesce to cover large areas of skin. Occasionally, pemphigus foliaceus progresses to involve the entire skin surface as an exfoliative erythroderma.<ref name="pmid159414332">{{cite journal| author=Chams-Davatchi C, Valikhani M, Daneshpazhooh M, Esmaili N, Balighi K, Hallaji Z et al.| title=Pemphigus: analysis of 1209 cases. | journal=Int J Dermatol | year= 2005 | volume= 44 | issue= 6 | pages= 470-6 | pmid=15941433 | doi=10.1111/j.1365-4632.2004.02501.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15941433  }}</ref>
* Pain or burning sensations frequently accompany the cutaneous lesions. Systemic symptoms are usually absent.
* Pain or burning sensations frequently accompany the cutaneous lesions. Systemic symptoms are usually absent.
|Positive Nikolsky sign.<ref name="pmid21353333">{{cite journal| author=Martin LK, Werth VP, Villaneuva EV, Murrell DF| title=A systematic review of randomized controlled trials for pemphigus vulgaris and pemphigus foliaceus. | journal=J Am Acad Dermatol | year= 2011 | volume= 64 | issue= 5 | pages= 903-8 | pmid=21353333 | doi=10.1016/j.jaad.2010.04.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21353333  }}</ref>
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* The skin lesions usually consist of small, scattered superficial blisters that rapidly evolve into scaly, crusted erosions
 
* Occasionally, pemphigus foliaceus progresses to involve the entire skin surface as an exfoliative erythroderma.<ref name="pmid159414332">{{cite journal| author=Chams-Davatchi C, Valikhani M, Daneshpazhooh M, Esmaili N, Balighi K, Hallaji Z et al.| title=Pemphigus: analysis of 1209 cases. | journal=Int J Dermatol | year= 2005 | volume= 44 | issue= 6 | pages= 470-6 | pmid=15941433 | doi=10.1111/j.1365-4632.2004.02501.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15941433  }}</ref>
* Positive Nikolsky sign<ref name="pmid21353333">{{cite journal| author=Martin LK, Werth VP, Villaneuva EV, Murrell DF| title=A systematic review of randomized controlled trials for pemphigus vulgaris and pemphigus foliaceus. | journal=J Am Acad Dermatol | year= 2011 | volume= 64 | issue= 5 | pages= 903-8 | pmid=21353333 | doi=10.1016/j.jaad.2010.04.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21353333  }}</ref>
|Autoimmune [[IgG]] build up in the [[Epidermis (skin)|epidermis]], then nearly almost all of the antibodies are aimed against [[desmoglein 1]]
|Autoimmune [[IgG]] build up in the [[Epidermis (skin)|epidermis]], then nearly almost all of the antibodies are aimed against [[desmoglein 1]]
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|[[Psoriasis|Pustular psoriasis]]
|[[Psoriasis|Pustular psoriasis]]
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* Patients with early disease onset often have a positive family history of psoriasis, frequent association with [[histocompatibility]] [[antigen]] (HLA)- Cw6, and more severe disease. Those with onset after the age of 40 usually have a negative family history and a normal frequency of the HLA- Cw6 allele.<sup>[[Psoriasis history and symptoms#cite note-pmid1390163-2|[2]]]</sup>
* Positive family history of psoriasis, frequent association with [[histocompatibility]] [[antigen]] (HLA)- Cw6.<sup>[[Psoriasis history and symptoms#cite note-pmid1390163-2|[2]]]</sup>
* A typical patient of psoriasis will present with a history of a long-term [[erythematous]] scaly area with [[ocular]] and [[joint]] involvement depending upon the clinical subtype and chronicity of the disease. There may be multiple relapses and remissions.
* A history of a long-term [[erythematous]] scaly area with [[ocular]] and [[joint]] involvement.
* Past medical history of the patient may include [[viral]] or [[bacterial]] infection, [[Diabetes mellitus|diabetes]], [[hypertension]], [[chronic kidney disease]] and/or [[obesity]] due to an association of psoriasis with these conditions.<sup>[[Psoriasis history and symptoms#cite note-pmid24790463-3|[3]]]</sup>
* Past medical history of the patient may include [[viral]] or [[bacterial]] infection, [[Diabetes mellitus|diabetes]], [[hypertension]], [[chronic kidney disease]] and/or [[obesity]].<sup>[[Psoriasis history and symptoms#cite note-pmid24790463-3|[3]]]</sup>
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* A long-term history of [[erythematous]] scaly area, which may involve multiple areas of the body    
* [[Pain]], which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning. 
* [[Pain]], which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis) 
* [[Pruritus]]
* [[Pruritus]] (especially in eruptive, guttate psoriasis)
* High [[fever]]
* High [[fever]]
* Dystrophic nails
* Dystrophic nails
* Long-term rash with recent presentation of [[arthralgia]]
* Recent presentation of [[arthralgia]]
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* [[Papulosquamous disorder|Papulosquamous]] [[disease]] with variable morphology, distribution, severity, and course
* [[Papulosquamous disorder|Papulosquamous]] [[disease]] with variable morphology, distribution, severity, and course
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* [[Woronoff|Woronoff’s ring]]: ring of peripheral blanching skin around a psoriatic [[plaque]]
* [[Woronoff|Woronoff’s ring]]: ring of peripheral blanching skin around a psoriatic [[plaque]]
* Auspitz’s sign: small [[bleeding]] points are seen upon disruption of a psoriatic scale.
* Auspitz’s sign: small [[bleeding]] points are seen upon disruption of a psoriatic scale.
|'''Skin biopsy'''
|
 
* '''Skin biopsy'''
Perivascular and [[dermal]] [[Inflammatory cells|inflammatory cell]] infiltration
* Perivascular and [[dermal]] [[Inflammatory cells|inflammatory cell]] infiltration
 
* [[Vascular]] dilation
[[Vascular]] dilation
* Absent [[granular layer]]
 
* Elongation of [[dermal]] [[Papilla|papillae]]
Absent [[granular layer]]
* Parakeratosis
 
* Spongiform [[pustules]] of Kogoj (pathognomic of psoriasis)
Elongation of [[dermal]] [[Papilla|papillae]]
* Munro's micro abscesses (pathognomic of psoriasis)
 
* [[Edema]] of [[dermal]] [[papillae]]
Parakeratosis
* [[Basal cell layer]] is expanded
 
* Leukocytosis
Spongiform [[pustules]] of Kogoj (pathognomic of psoriasis)
 
Munro's micro abscesses (pathognomic of psoriasis)
 
[[Edema]] of [[dermal]] [[papillae]]
 
In psoriasis, skin [[biopsy]] of the affected area of skin shows that the [[Epidermis (skin)|epidermal]]/supra-papillary thickness ratio is increased
 
[[Basal cell layer]] is expanded
 
Leukocytosis
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|[[Acrodermatitis enteropathica]]
|[[Acrodermatitis enteropathica]]
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* It is an [[autosomal]] [[recessive]] disorder characterized by periorificial and acral [[dermatitis]], [[alopecia]], and [[diarrhea]].
* An [[autosomal]] [[recessive]] disorder characterized by periorificial and acral [[dermatitis]], [[alopecia]], and [[diarrhea]].
* The genetic base is a [[mutation]] of [[SLC39A4]] which encodes a [[transmembrane protein]] that serves as a zinc uptake protein. 
* The genetic base is a [[mutation]] of [[SLC39A4]] which encodes a [[transmembrane protein]] that serves as a zinc uptake protein. 
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* The lesions may appear eczematous or may evolve further into crusted vesicles, bullae or pustules.  
* The lesions may appear eczematous or may evolve further into crusted vesicles, bullae or pustules.  
* The lesions are frequent around natural orifices like the mouth perioral and anus peri-anal, and also in hands, feet, and [[scalp]].  
* The lesions are frequent around natural orifices like the mouth perioral and anus peri-anal, and also in hands, feet, and [[scalp]].  
* There may be [[suppurative]] inflammation of the nail fold surrounding the nail plate - known as [[paronychia]]. 
* [[paronychia]] 
* Alopecia of the scalp, eyebrows, and eyelashes may occur. 
* Alopecia of the scalp, eyebrows, and eyelashes 
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* Measurement of zinc in plasma, erythrocytes, neutrophils, lymphocytes, and hair.  
* Measurement of zinc in plasma, erythrocytes, neutrophils, lymphocytes, and hair.  
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|[[Pellagra]]
|[[Pellagra]]
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* It is Niacin deficincy disease characterized by a photosensitive pigmented dermatitis (typically located in sun-exposed areas), diarrhea, and dementia.
* It is a niacin deficiency disease characterized by a photosensitive pigmented dermatitis, diarrhea, and dementia.
* Hisotry of alcoholics, bariatric surgery, anorexia nervosa, or malabsorptive disease.<ref name="pmid12777163">{{cite journal| author=Prousky JE| title=Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature. | journal=Altern Med Rev | year= 2003 | volume= 8 | issue= 2 | pages= 180-5 | pmid=12777163 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12777163  }}</ref>  
* Hisotry of alcoholics, bariatric surgery, anorexia nervosa, or malabsorptive disease.<ref name="pmid12777163">{{cite journal| author=Prousky JE| title=Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature. | journal=Altern Med Rev | year= 2003 | volume= 8 | issue= 2 | pages= 180-5 | pmid=12777163 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12777163  }}</ref>  
* Dietary deficiency especially in infants
* Dietary deficiency especially in infants
* Past history of Carcinoid syndrome, in which metabolism of tryptophan is to 5-OH tryptophan and serotonin rather than to nicotinic acid. This leads to the deficiency of active forms of niacin and the development of pellagra.
* Past history of Carcinoid syndrome  
* Prolonged use of isoniazid.<ref name="pmid21128910">{{cite journal| author=Wan P, Moat S, Anstey A| title=Pellagra: a review with emphasis on photosensitivity. | journal=Br J Dermatol | year= 2011 | volume= 164 | issue= 6 | pages= 1188-200 | pmid=21128910 | doi=10.1111/j.1365-2133.2010.10163.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21128910  }}</ref>
* Prolonged use of isoniazid<ref name="pmid21128910">{{cite journal| author=Wan P, Moat S, Anstey A| title=Pellagra: a review with emphasis on photosensitivity. | journal=Br J Dermatol | year= 2011 | volume= 164 | issue= 6 | pages= 1188-200 | pmid=21128910 | doi=10.1111/j.1365-2133.2010.10163.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21128910  }}</ref>
* A family history of Hartnup disease which is a congenital defect of a membrane transport in the intestinal and renal cells normally responsible for the absorption of tryptophan.
* A family history of Hartnup disease
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|N
* [[Photosensitivity]]
|Symmetric hyper pigmented rash, similar in color and distribution to a sunburn, which is present in the exposed areas of skin.
* Pigmented dermatitis (typically located in [[sun-exposed areas]])
* [[Diarrhea]]
* [[Dementia]]
* [[Glossitis]]
 
* [[Insomnia]]
* [[Weakness|Weakness]]
* [[Mental confusion]]
|The most characteristic finding is the presence of a symmetric hyper pigmented rash, similar in color and distribution to a sunburn, which is present in the exposed areas of skin.
|Niacin status can be assessed by measuring urinary N-methylnicotinamide or by measuring the erythrocyte NAD/NADP (ratio). 
|Niacin status can be assessed by measuring urinary N-methylnicotinamide or by measuring the erythrocyte NAD/NADP (ratio). 
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|[[eczema|Chronic eczema]] (atopic dermatitis)
|[[eczema|Chronic eczema]] (atopic dermatitis)
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* Atopic dermatitis is a chronic pruritic inflammatory skin disease that occurs most frequently in children but also affects adults.  
* It is a chronic pruritic inflammatory skin disease that occurs most frequently in children but also affects adults.  
* A family history of atopy (eczema, asthma, or allergic rhinitis) and the loss-of-function mutations in the filaggrin (''FLG'') gene, involved in the skin barrier function, are major risk factors for atopic dermatitis.
* A family history of atopy (eczema, asthma, or allergic rhinitis)
* History of dermatitis involving the skin creases.
* History of dermatitis involving the skin creases
* Personal or family history of asthma or hay fever.
* Personal or family history of asthma or hay fever
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* Symptoms beginning in a child before the age of 2 years or, in children <4 years, dermatitis affecting the cheeks or dorsal aspect of extremities.
* Symptoms beginning in a child before the age of 2 years or, in children <4 years, dermatitis affecting the cheeks or dorsal aspect of extremities.
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* Erythema, papulation, oozing and crusting, excoriation.
* Erythema, papulation, oozing and crusting, excoriation.
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* Raised [[IgE]] or an [[eosinophilia]].
* Raised [[IgE]] or an [[eosinophilia]]
* [[RAST test|Radioallergosorbent Test]] Paper Radioimmunosorbent Test: in the test, blood is mixed separately with many different allergens and the antibody levels measured.
* [[RAST test|Radioallergosorbent Test]]: blood is mixed separately with many different allergens and the antibody levels measured.
* High levels of antibodies in the blood signify an allergy to that substance.
* High levels of antibodies in the blood signify an allergy to that substance
* Skin biopsy which is a procedure that removes a small piece of the affected skin that is sent for microscopic examination in a pathology laboratory.
* Skin biopsy: a procedure that removes a small piece of the affected skin and sent for microscopic examination in a pathology laboratory.
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Revision as of 18:51, 3 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Glucagonoma must be differentiated from certain skin lesions (acrodermatitis enteropathica, psoriasis, pellagra, eczema) and other causes of hyperglucagonemia (infection, diabetes mellitus, Cushing syndrome, renal failure, acute pancreatitis, severe stress, and prolonged fasting).

Differentiating Glucagonoma from other Diseases

Glucagonoma must be differentiated from certain skin lesions in which necrolytic migratory erythema can be found and other causes of hyperglucagonemia:[1][2]

Disease Clinical Picture Investigations Pictures
History Symptoms Signs
Glucagonoma A family history of multiple endocrine neoplasia type 1
  • Serum glucagon[1]
    • Increased plasma glucagon levels (>500 pg/mL).[3]
    • Concentrations above 1000 pg/mL are diagnostic of glucagonoma.[4]
  • CT scans are used to determine the location of the tumor, show the organs nearby. Liver metastases may appear isodense with the liver on a non-contrasted study.[4]
Pemphigus foliaceus  Autoimmune blistering disease of the skin with characteristic lesions that are scaly, crusted erosions, often on an erythematous base.[1]

Mucosal involvement is absent even with widespread disease.[2]

  • The main symptom is a cutaneous lesion that usually develops in a seborrheic distribution:[3]the scalp, face, and trunk are common sites of involvement.
  • The skin lesions may remain localized or may coalesce to cover large areas of skin.
  • Pain or burning sensations frequently accompany the cutaneous lesions. Systemic symptoms are usually absent.
  • The skin lesions usually consist of small, scattered superficial blisters that rapidly evolve into scaly, crusted erosions
  • Occasionally, pemphigus foliaceus progresses to involve the entire skin surface as an exfoliative erythroderma.[4]
  • Positive Nikolsky sign[5]
 Autoimmune IgG build up in the epidermis, then nearly almost all of the antibodies are aimed against desmoglein 1
Pustular psoriasis
  • Pain, which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning. 
  • Pruritus
  • High fever
  • Dystrophic nails
  • Recent presentation of arthralgia
Acrodermatitis enteropathica
  • Symptoms appear in infants after breast milk weaning.
  • The appearance of erythematous patches and plaques of dry, scaly skin.
  • Diarrhea may occur.
  • Erythematous patches and plaques of dry, scaly skin.
  • The lesions may appear eczematous or may evolve further into crusted vesicles, bullae or pustules.
  • The lesions are frequent around natural orifices like the mouth perioral and anus peri-anal, and also in hands, feet, and scalp.
  • paronychia 
  • Alopecia of the scalp, eyebrows, and eyelashes 
  • Measurement of zinc in plasma, erythrocytes, neutrophils, lymphocytes, and hair.
  • A low plasma zinc usually is defined as a value less than 60 mcg/dL.
  • Zinc levels in neutrophils or lymphocytes may be more sensitive than plasma zinc.[6]
  • The criteria for zinc deficiency are decreased zinc level in either lymphocyte.[7]
  • Depressed serum alkaline phosphatase levels for age provide supportive evidence for zinc deficiency.[8]
Pellagra
  • It is a niacin deficiency disease characterized by a photosensitive pigmented dermatitis, diarrhea, and dementia.
  • Hisotry of alcoholics, bariatric surgery, anorexia nervosa, or malabsorptive disease.[9]
  • Dietary deficiency especially in infants
  • Past history of Carcinoid syndrome
  • Prolonged use of isoniazid[10]
  • A family history of Hartnup disease
 N Symmetric hyper pigmented rash, similar in color and distribution to a sunburn, which is present in the exposed areas of skin. Niacin status can be assessed by measuring urinary N-methylnicotinamide or by measuring the erythrocyte NAD/NADP (ratio). 
Chronic eczema (atopic dermatitis)
  • It is a chronic pruritic inflammatory skin disease that occurs most frequently in children but also affects adults.
  • A family history of atopy (eczema, asthma, or allergic rhinitis)
  • History of dermatitis involving the skin creases
  • Personal or family history of asthma or hay fever
  • Symptoms beginning in a child before the age of 2 years or, in children <4 years, dermatitis affecting the cheeks or dorsal aspect of extremities.
  • Dry skin and severe pruritus that is associated with cutaneous hyperreactivity to various environmental stimuli
  • including exposure to food and inhalant allergens, irritants, and infection.
  • Visible dermatitis involving flexural surfaces.
  • Presence of generally dry skin within the past year
  • Erythema, papulation, oozing and crusting, excoriation.
  • Raised IgE or an eosinophilia
  • Radioallergosorbent Test: blood is mixed separately with many different allergens and the antibody levels measured.
  • High levels of antibodies in the blood signify an allergy to that substance
  • Skin biopsy: a procedure that removes a small piece of the affected skin and sent for microscopic examination in a pathology laboratory.

References

  1. ↑ Glucagonoma. Wikipedia. https://en.wikipedia.org/wiki/Glucagonoma. accessed on October 10, 2015
  2. ↑ Fang S, Li S, Cai T (2014). "Glucagonoma syndrome: a case report with focus on skin disorders". Onco Targets Ther. 7: 1449–53. doi:10.2147/OTT.S66285. PMC 4140234. PMID 25152626.
  3. ↑ Bystryn JC, Rudolph JL (2005). "Pemphigus". Lancet. 366 (9479): 61–73. doi:10.1016/S0140-6736(05)66829-8. PMID 15993235.
  4. ↑ Chams-Davatchi C, Valikhani M, Daneshpazhooh M, Esmaili N, Balighi K, Hallaji Z; et al. (2005). "Pemphigus: analysis of 1209 cases". Int J Dermatol. 44 (6): 470–6. doi:10.1111/j.1365-4632.2004.02501.x. PMID 15941433.
  5. ↑ Martin LK, Werth VP, Villaneuva EV, Murrell DF (2011). "A systematic review of randomized controlled trials for pemphigus vulgaris and pemphigus foliaceus". J Am Acad Dermatol. 64 (5): 903–8. doi:10.1016/j.jaad.2010.04.039. PMID 21353333.
  6. ↑ Prasad AS, Cossack ZT (1984). "Zinc supplementation and growth in sickle cell disease". Ann Intern Med. 100 (3): 367–71. PMID 6696358.
  7. ↑ Meftah S, Prasad AS, Lee DY, Brewer GJ (1991). "Ecto 5' nucleotidase (5'NT) as a sensitive indicator of human zinc deficiency". J Lab Clin Med. 118 (4): 309–16. PMID 1940572.
  8. ↑ Kiliç I, Ozalp I, Coŝkun T, Tokatli A, Emre S, Saldamli I; et al. (1998). "The effect of zinc-supplemented bread consumption on school children with asymptomatic zinc deficiency". J Pediatr Gastroenterol Nutr. 26 (2): 167–71. PMID 9481631.
  9. ↑ Prousky JE (2003). "Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature". Altern Med Rev. 8 (2): 180–5. PMID 12777163.
  10. ↑ Wan P, Moat S, Anstey A (2011). "Pellagra: a review with emphasis on photosensitivity". Br J Dermatol. 164 (6): 1188–200. doi:10.1111/j.1365-2133.2010.10163.x. PMID 21128910.


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