Somatostatin Receptor PET/CT in a Glucagonoma Presenting With Necrolytic Migratory Erythema and Normoglucagonemia: A Diagnostic Dilemma.

Glucagonoma is a rare pancreatic neuroendocrine tumor characterized by necrolytic migratory erythema (NME), diabetes, and weight loss. Diagnosis can be difficult, especially when serum glucagon levels are normal. We report a case of a 49-year-old woman with chronic pruritic skin lesions and significant weight loss. Skin biopsy confirmed NME, while laboratory tests showed hyperglycemia and normal serum glucagon. A 68 Ga-DOTANOC PET/CT scan revealed a somatostatin receptor-expressing mass in the pancreas. Surgical resection confirmed a grade 2 pancreatic NET consistent with glucagonoma, emphasizing that normal glucagon levels do not rule out glucagonoma and highlighting the utility of SSTR PET/CT in diagnosis.