Glucagonoma is a very rare tumor of the islet cells of the pancreas, which release the hormones insulin and glucagon.

Glucagonoma is usually cancerous (malignant). The cancer tends to spread and get worse.

This cancer affects the islet cells of the pancreas. As a result, they produce too much of the hormone glucagon.

The cause is unknown, but genetic factors play a role in some cases. A family history of multiple endocrine neoplasia type I (MEN I) is a risk factor.

• Diarrhea
• Excess thirst
• Frequent urination
• Increased appetite
• Inflamed mouth and tongue
• Nighttime (nocturnal) urination
• Skin rash on face, abdomen, buttocks, or lower extremities that comes and goes, and moves around
  • May be crusty or scaly
  • May be raised sores (lesions) filled with clear fluid or pus
• Unintentional weight loss

Signs include:

• Glucose intolerance
• High blood sugar (hyperglycemia)

Most of the time the cancer has already spread to the liver when it is diagnosed.

Tests may include:

• CT scan
• Fasting glucoselevel
• Glucose tolerance test
• Serum glucagon

Surgery to remove the tumor is the preferred treatment. The tumor does not respond to chemotherapy.

Approximately 60% of these tumors are cancerous. Spread to the liver is common.

If the tumor is only in the pancreas and surgery to remove it is successful, patients have a 5-year survival rate of 85%.

The cancer can spread to the liver.

Call your health care provider if you notice symptoms of glucagonoma.

Simon P, Spilcke-Liss E, Wallaschofski H. Endocrine tumors of the pancreas. Endocrinol Metabl Clin North Am. 2006;35:431-437.

A glucagon test measures the amount of a hormone called glucagon in your blood. Glucagon is produced by cells in the pancreas. It helps control blood sugar levels.

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

A specific laboratory technique called radioimmunoassay (RIA) is used to check for the hormone glucagon in the blood.

Your health care provider will tell you if you need to fast for a period of time before the test.

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Glucagon stimulates the liver to release glucose. As the level of blood sugar decreases, the pancreas releases more glucagon, and vice versa.

Your health care provider may measure your glucagon levels if you show symptoms of:

• Low blood sugar (hypoglycemia)
• Mild diabetes
• A skin rash called necrolytic migratory erythema
• Unexplained weight loss

The normal range is 50 - 100 pg/mL.

Note: pg/mL = picograms per milliliter

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

• Abnormal glucagon levels may be due to multiple endocrine neoplasia (MEN) type I.
• In a rare syndrome, a tumor in the pancreas called a glucagonoma can produce excess glucagon and cause diabetes.
• People with insulin resistance or type 2 diabetes often produce very high levels of glucagon.

Veins vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

A glucagon test measures the amount of a hormone called glucagon in your blood. Glucagon is produced by cells in the pancreas. It helps control blood sugar levels.

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

A specific laboratory technique called radioimmunoassay (RIA) is used to check for the hormone glucagon in the blood.

Your health care provider will tell you if you need to fast for a period of time before the test.

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Glucagon stimulates the liver to release glucose. As the level of blood sugar decreases, the pancreas releases more glucagon, and vice versa.

Your health care provider may measure your glucagon levels if you show symptoms of:

• Low blood sugar (hypoglycemia)
• Mild diabetes
• A skin rash called necrolytic migratory erythema
• Unexplained weight loss

The normal range is 50 - 100 pg/mL.

Note: pg/mL = picograms per milliliter

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

• Abnormal glucagon levels may be due to multiple endocrine neoplasia (MEN) type I.
• In a rare syndrome, a tumor in the pancreas called a glucagonoma can produce excess glucagon and cause diabetes.
• People with insulin resistance or type 2 diabetes often produce very high levels of glucagon.

Veins vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Review Date: 11/21/2010

Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A blood glucose test measures the amount of a sugar, called glucose, in a sample of your blood.

Glucose is a major source of energy for most cells of the body, including those in the brain. The carbohydrates you eat eventually end up as glucose in the blood.

See also:

• Glucose test - CSF
• Glucose test - urine
• Glucose tolerance test
• Home blood glucose monitoring

Random blood sugar; Blood sugar level; Fasting blood sugar

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

The test may be done while you are fasting or at random.

If you are having a fasting glucose blood test, you should NOT eat or drink for 8 hours before the test.

A random glucose test can be done at any time of the day, but results depend on what you drink or eat before the test, as well as your activity.

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Your doctor may order this test if you have signs of diabetes. However, other tests (glucose tolerance test and fasting blood glucose test) must be used to diagnose diabetes.

The blood glucose test is also used to monitor patients who have the diabetes. It may also be done if you have:

• A seizure for the first time
• Strange changes in behavior
• Fainting spells

Levels vary according to the laboratory, but in general up to 100 milligrams per deciliter (mg/dL) are considered normal for a fasting blood glucose test.

Persons with levels between 100 and 125 mg/dL have impaired fasting glucose, or prediabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.

Diabetes is diagnosed in persons with fasting blood glucose levels that are 126 mg/dL or higher.

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

Greater-than-normal blood glucose levels (hyperglycemia) may be a sign of diabetes. In someone with diabetes, it may mean the diabetes is not well controlled.

Increased levels may also be due to:

• Acromegaly(very rare)
• Cushing syndrome (rare)
• Glucagonoma
• Impaired fasting glucose (also called "prediabetes")
• Hyperthyroidism
• Pancreatic cancer
• Pancreatitis
• Pheochromocytoma (very rare)

Lower-than-normal levels (hypoglycemia) may indicate:

• Hypopituitarism
• Hypothyroidism
• Insulinoma(very rare)
• Too little food
• Too much insulin or other diabetes medications

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Many forms of severe stress (for example, trauma, stroke, heart attack, and surgery) can temporarily increase blood glucose levels.

Drugs that can increase glucose measurements include the following:

• Atypical antipsychotics, especially olanzapine and risperidone
• Corticosteroids
• Diazoxide
• Dextrose
• Diuretics
• Epinephrine
• Estrogens
• Glucagon
• Isoniazid
• Lithium
• Phenothiazines
• Phenytoin
• Salicylates (see aspirin overdose)
• Triamterene
• Tricyclic antidepressants

Drugs that can decrease glucose measurements include the following:

• Acetaminophen
• Alcohol
• Anabolic steroids
• Clofibrate
• Disopyramide
• Gemfibrozil
• Monoamine oxidase inhibitors (MAOIs)
• Pentamidine
• Sulfonylurea medications (such as glipizide, glyburide, and glimepiride)

American Diabetes Association. Standards of medical care in diabetes -- 2009. Diabetes Care. 2009;32:S13-S61.

Inzucchi SE, Sherwin RS. Type 2 diabetes mellitus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 248.