|
|
| Line 6: |
Line 6: |
|
| |
|
| ==Differentiating Glucagonoma from other Diseases== | | ==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:<ref>Glucagonoma. Wikipedia. https://en.wikipedia.org/wiki/Glucagonoma. accessed on October 10, 2015</ref><ref name="pmid25152626">{{cite journal| author=Fang S, Li S, Cai T| title=Glucagonoma syndrome: a case report with focus on skin disorders. | journal=Onco Targets Ther | year= 2014 | volume= 7 | issue= | pages= 1449-53 | pmid=25152626 | doi=10.2147/OTT.S66285 | pmc=PMC4140234 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25152626 }} </ref> | | Glucagonoma must be differentiated from certain skin lesions in which necrolytic migratory erythema can be found such as:<ref>Glucagonoma. Wikipedia. https://en.wikipedia.org/wiki/Glucagonoma. accessed on October 10, 2015</ref><ref name="pmid25152626">{{cite journal| author=Fang S, Li S, Cai T| title=Glucagonoma syndrome: a case report with focus on skin disorders. | journal=Onco Targets Ther | year= 2014 | volume= 7 | issue= | pages= 1449-53 | pmid=25152626 | doi=10.2147/OTT.S66285 | pmc=PMC4140234 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25152626 }} </ref> |
| <small><small>
| |
| {| class="wikitable"
| |
| ! rowspan="2" |Disease
| |
| ! colspan="3" |Clinical Picture
| |
| ! rowspan="2" |Investigations
| |
| ! rowspan="2" |Pictures
| |
| |-
| |
| !History
| |
| !Symptoms
| |
| !Signs
| |
| |-
| |
| |Glucagonoma
| |
| |A family history of [[multiple endocrine neoplasia type 1]]
| |
| |
| |
| * [[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>
| |
| * [[Glucose intolerance]]<sup>[[Glucagonoma history and symptoms#cite note-pmid6268399-4|[4]]]</sup>
| |
| |
| |
| * [[Rash|Rash:]] Erythematous, ring shaped [[rash]] that blisters, erodes, and crusts over suggesting [[necrolytic migratory erythema]].
| |
| * Muscle [[atrophy]] may be present.
| |
| * Unilateral calf or thigh erythema, and swelling.
| |
| * Hyporeflexia
| |
| * Unilateral/bilateral [[sensory loss]] in the upper/lower extremity
| |
| |
| |
| * '''Serum glucagon'''<sup>[[Glucagonoma laboratory tests#cite note-pmid15313692-1|[1]]]</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>
| |
|
| |
|
| * 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>
| | A[[acrodermatitis enteropathica|crodermatitis enteropathica]] |
| |[[File:NEM1.jpg|center|250px]]
| |
| |-
| |
| |[[Pemphigus foliaceus]]
| |
| |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>
| | [[psoriasis|pustular psoriasis]] |
|
| |
|
| |
| | [[pellagra]] |
| * 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.
| |
|
| |
|
| * The skin lesions may remain localized or may coalesce to cover large areas of skin.
| | [[eczema]] |
| * 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.<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>
| | <small><small> |
| * 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]]
| |
| |[[File:Pemphigus foliaceus08.jpg|center|250px]]
| |
| |-
| |
| |[[Psoriasis|Pustular psoriasis]]
| |
| |
| |
| * Positive family history of psoriasis, frequent association with [[histocompatibility]] [[antigen]] (HLA)- Cw6.<sup>[[Psoriasis history and symptoms#cite note-pmid1390163-2|[2]]]</sup>
| |
| * 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]].<sup>[[Psoriasis history and symptoms#cite note-pmid24790463-3|[3]]]</sup>
| |
| |
| |
| * [[Pain]], which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning.
| |
| * [[Pruritus]]
| |
| * High [[fever]]
| |
| * Dystrophic nails
| |
| * Recent presentation of [[arthralgia]]
| |
| |
| |
| * [[Papulosquamous disorder|Papulosquamous]] [[disease]] with variable morphology, distribution, severity, and course
| |
| * Scaling [[Papule|papules]] and [[Plaque|plaques]]
| |
| * [[Koebner phenomenon]]: appearance of new psoriatic lesions at the site of skin injury
| |
| * [[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.
| |
| |
| |
| * '''Skin biopsy'''
| |
| * Perivascular and [[dermal]] [[Inflammatory cells|inflammatory cell]] infiltration
| |
| * [[Vascular]] dilation
| |
| * Absent [[granular layer]]
| |
| * Elongation of [[dermal]] [[Papilla|papillae]]
| |
| * Parakeratosis
| |
| * Spongiform [[pustules]] of Kogoj (pathognomic of psoriasis)
| |
| * Munro's micro abscesses (pathognomic of psoriasis)
| |
| * [[Edema]] of [[dermal]] [[papillae]]
| |
| * [[Basal cell layer]] is expanded
| |
| * Leukocytosis
| |
| |[[File:Pus.png|center|250px]]
| |
| |-
| |
| |[[Acrodermatitis enteropathica]]
| |
| |
| |
| * 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.
| |
| |
| |
| * 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.<ref name="pmid6696358">{{cite journal| author=Prasad AS, Cossack ZT| title=Zinc supplementation and growth in sickle cell disease. | journal=Ann Intern Med | year= 1984 | volume= 100 | issue= 3 | pages= 367-71 | pmid=6696358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6696358 }}</ref>
| |
| * The criteria for zinc deficiency are decreased zinc level in either lymphocyte.<ref name="pmid1940572">{{cite journal| author=Meftah S, Prasad AS, Lee DY, Brewer GJ| title=Ecto 5' nucleotidase (5'NT) as a sensitive indicator of human zinc deficiency. | journal=J Lab Clin Med | year= 1991 | volume= 118 | issue= 4 | pages= 309-16 | pmid=1940572 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1940572 }}</ref>
| |
| * Depressed serum alkaline phosphatase levels for age provide supportive evidence for zinc deficiency.<ref name="pmid9481631">{{cite journal| author=Kiliç I, Ozalp I, Coŝkun T, Tokatli A, Emre S, Saldamli I et al.| title=The effect of zinc-supplemented bread consumption on school children with asymptomatic zinc deficiency. | journal=J Pediatr Gastroenterol Nutr | year= 1998 | volume= 26 | issue= 2 | pages= 167-71 | pmid=9481631 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9481631 }}</ref>
| |
| |[[File:Acrodermatitis enteropathica 05.png|center|250px]]
| |
| |-
| |
| |[[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.<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
| |
| * 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>
| |
| * A family history of Hartnup disease
| |
| |
| |
| * Photosensitivity
| |
| * Pigmented dermatitis in sun-exposed areas
| |
| * Diarrhea
| |
| * Dementia
| |
| |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).
| |
| |[[File:Pellagra24.jpg|center|250px]]
| |
| |-
| |
| |[[eczema|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]]
| |
| * [[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
| |
| * Skin biopsy: a procedure that removes a small piece of the affected skin and sent for microscopic examination in a pathology laboratory.
| |
| |[[File:Atopic Dermatitis27.jpg|center|250px]]
| |
| |}
| |
| </small></small> | | </small></small> |
|
| |
|