• Jena Martin MD

Diagnosis Decisions- Endocrine

***Great Moments in Pathology TM***

I knew instinctively what this disease was. It didn’t even feel like a decision. ⠀⠀⠀ ⠀⠀ That’s the best kind of case to have. An easy, and in this case, super interesting diagnosis. ⠀⠀⠀ ⠀ But can I just stop there, name it and move on? Nope. I had to stop and try to prove my instincts wrong.

What else can this be, I asked. That’s the way to seek the truth and reach real decisions. This kind of second guessing one’s instincts is part of the scientific method. ⠀⠀

For those of you wondering what this is, the pale surface of the epidermis is the diagnostic clue.

It’s called necrolytic migratory erythema. What else could it be? Things that mimic it are vitamin deficiencies (zinc, or niacin; the names of those diseases respectively are acrodermatitis enteropathica and pellagra). ⠀

⠀⠀ What makes this a great teaching case is that the rash of necrolytic migratory erythema is uniformly associated with an internal cancer called glucagonoma. The tumor secretes too much glucagon, which causes the rash. Once the tumor is removed, the rash resolves. The rash is a paraneoplastic symptom. This demonstrates why dermatologist could be more accurately called ‘externists’! ⠀⠀

***TM - This phrase: "Great Moments in Pathology" is my personal term for those amazing cases where we, the pathologist, clinches an unexpected diagnosis. It's a fist-pumping, celebratory moment when one recognizes these rarities. A Great Moment.

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