Pancreatic islet cell carcinoma associated with multiple hormone secretion and pancytopenia. Evidence of a serum factor suppressing hematopoiesis.

A case of metastatic islet cell carcinoma of the pancreas associated with the production of multiple polypeptide hormones (insulin, glucagon, and gastrin) is described. Three years prior to the histologic diagnosis the patient presented with a gastric ulcer and an androgen responsive pancytopenia with hypoplastic bone marrow. Discontinuation of androgen therapy resulted in relapse of pancytopenia. After the diagnosis of islet cell carcinoma of the pancreas was established, the patient was treated with 5-fluorouracil (5-FU) and streptozotocin and subsequently elevated serum polypeptide hormones returned toward normal levels. Concurrent with the normalization of peptide hormones another complete hematologic remission was achieved without use of androgens. Injection of the patient's serum into female rats produced a significant fall in leukocyte (P less than 0.02) and platelet counts (P less than 0.005), but no significant decrease in hematocrit. The clinical course and laboratory findings in this case suggest the presence of a previously undescribed serum factor released by an islet cell tumor capable of suppressing hematopoiesis.

Duke Scholars

Author Thomas Norton Denny Medicine, Duke Human Vaccine Institute