Dysglycemia in non-functioning pancreatic neuroendocrine tumors (NF-PNET): Further insights into an under recognized entity

Esther Osher; Ravit Geva; Ido Wolf; Karen Tordjman; Joseph Klausner; Yael Sofer; Erez Scapa; Oren Shibolet; Dana Ben-Ami Shor; Iddo Bar-Yishay; Nir Lubezky; Yaacov Goykhman; Guy Lahat; Oz Yakir; Sharon Pelles; Asaf Aizic; Arye Blachar; Naftali Stern; Yona Greenman

doi:10.1016/j.jcte.2023.100322

Dysglycemia in non-functioning pancreatic neuroendocrine tumors (NF-PNET): Further insights into an under recognized entity

J Clin Transl Endocrinol. 2023 Aug 17:33:100322. doi: 10.1016/j.jcte.2023.100322. eCollection 2023 Sep.

Authors

Esther Osher¹, Ravit Geva², Ido Wolf², Karen Tordjman¹, Joseph Klausner³, Yael Sofer¹, Erez Scapa⁴, Oren Shibolet⁴, Dana Ben-Ami Shor⁴, Iddo Bar-Yishay⁴, Nir Lubezky³, Yaacov Goykhman³, Guy Lahat³, Oz Yakir³, Sharon Pelles², Asaf Aizic⁵, Arye Blachar⁶, Naftali Stern¹, Yona Greenman¹

Affiliations

¹ Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel.
² Department of Oncology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel.
³ Department of Surgery, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel.
⁴ Department of Gastroenterology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel.
⁵ Institute of Pathology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel.
⁶ Insitute of Radiology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel.

Abstract

Objective: Pancreatic neuroendocrine tumors (PNETs) are rare, but their incidence has risen significantly in recent years. Whereas diabetes mellitus (DM) is recognized in association with chronic pancreatitis and pancreatic cancer, it has not been well-characterized concerning non-functioning (NF)-PNETs.Study aim: to determine whether NF-PNETs are associated with DM/ Pre-DM and characterize the features of this putative association.

Methods: Retrospective study to evaluate rate of Pre-DM /DM in subjects with NF-PNETs.

Results: Study cohort of 129 patients with histologically confirmed NF-PNETs, ∼60% were men (M/F: 77/52). Abnormal glucose metabolism that preceded any treatment was seen in 70% of this cohort: overt DM in 34% and Pre-DM in 36% of the subjects. However, during follow-up, the overall prevalence rose to 80.6%, owing exclusively to newly diagnosed DM in subjects who received treatment.Patients with DM/Pre-DM were older (65 ± 11; 54 ± 14; p < 0.0001), the tumor was more commonly localized in the pancreatic body and tail (76.5% vs. 23.5% p = 0.03), while BMI (27 ± 6 vs. 28 ± 5 kg/m2), and tumor size (2.4 ± 2 vs. 2.9 ± 3.2 cm) were similar. The relative prevalence of DM in our cohort of NF-PNETs was 1.6 higher than that in the age and gender-adjusted general Israeli population (95 %CI: 1.197-2.212p = 0.03).

Conclusions: We found a high rate of impaired glucose metabolism, either DM or Pre-DM, in a large cohort of NF-PNETs. The high prevalence of diabetes/pre-diabetes was unrelated to obesity or tumor size. This observation should increase awareness of the presence of DM on presentation or during treatment of "NF"-PNETs.

Keywords: Dysglycemia; NF-PNET; Type 3c diabetes mellitus.