ENDOCRINE PANCREAS

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ENDOCRINE PANCREAS
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• Diabetes Mellitus
• Islet Cell tumors

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INTRODUCTION

• One million islets of Langerhans
• Several types of cells Immunohistochemistery
• ß (beta) -gt 70 insulin
• ? (alpha) -gt 20 glucagons
• D (delta) -gt 5-10 somatostatin
• P.P Cell -gt 1-2 pancreatic polypeptide
• Other rare cells
  - D1 cells
  
  - VIP ( vasoactive
  intestinal polypeptide )
  - Enterochromaffin cells
  - 5
  HT-(serotonin)

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• Each type of pancreatic islet cells may give
  mainly benign tumour -gt (ADENOMA) called Islet
  cell tumours Insulinoma
  Glucagonoma Somatostatinoma VIPoma Carcinoid
  tumours Gastrinoma
• Multiple Endocrine Neoplasia (MEN)

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DIABETES MELLITUS
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DEFINITION

• Diabetes Mellitus is a chronic disorder of
  carbohydrate, fat, and protein metabolism.
• In which there is impaired glucose utilization
  due to defective or deficient insulin secretory
  response inducing hyperglycemia

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CLASSIFICATION

• Primary (idiopathic) Diabetes Mellitus
• Type-1 (Insulin Dependent Diabetes Mellitus)
• Type-1A (immune mediated)
• Type-1B (idiopathic)
• Type-2 (Non-insulin Dependent Diabetes Mellitus)
  
• Non-obese NIDDM
• Obese NIDDM
• Maturity onset diabetes of the young (MOD)
• Gestational DM

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• Secondary Diabetes Mellitus
• - Chronic pancreatitis
• - Post pancreatectomy
• - Hormonal tumours (acromegaly, Cushings ---)
• - Drugs (corticosteroids)
• - Haemochromatosis
• - Genetic disorders e.g. lipodystrophy
• - Gestational DM

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• Primary Diabetes Mellitus is by far the most
  common in our countery and worldwide.
  Type 1 and type2 have
  different pathogenetic and metabolic
  characeristics.
  Simillar long term comlications occur in both
  types.

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• MODY (maturity-onset DM of the Young)
• Young
• Rare
• Linked to chrom. 7 20
• Autosomal dominant
• Mild hyperglycemia

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• ACUTE METABOLIC COMPLICATIONS

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Diabetic Ketoacidosis coma

• In Type I Diabetes Mellitus
• Due to severe insulin deficiency with increase
  glucagons .
• Decrease insulin ? lipolysis ?free fatty
  acids ? Increase Glucagon ? oxidation of
  FFA in liver ?Ketoacidosis
• ? Coma

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Non ketotic Hyperosmolar Coma

• In Type II DM (NIDDM)
• Elderly
• Uncontroled DM
• Sustained hyperglycemic diuresis ?
• Severe dehydration ? coma
• Lack of symptoms (nausea, vomiting and
  respiratory difficulties)? Delay the seeking of
  medical attention.
• Hypoglycemia Coma

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Morphology Late Complications

• Depends on
• - Duration
• - Metabolic control
• - Genetic factors

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• Microangiopathy
• Thickening of basement membrane PAS
  Advanced glycosylation end product .
• - Renal Glomeruli? ( (nephropathy
• - Retina ?( (retinopathy
• - Nerves? (neuropathy)

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• Atherosclerosis
• - Myocardial infarction
• - Cerebral stroke .
• - Aortic aneurysm .
• - Gangrene of lower extremities

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• Neuropathy
• - Symmetric peripheral neuropathy .
• - Sexual impotence .
• -Bowel and bladder dysfunction.

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Diabetic Nephropathy

• Glomerular involvement
• Diffuse glomerulosclerosis .
• Nodular glomerulosclerosis
  KimmelStiel Wilson
  lesion
• ? Nephrotic Syndrome
• Arteriolosclerosis
• Pyelonephritis (acute chronic)
• Necrotizing papillitis .

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Diabetic Ocular complications

• - Retinopathy
• Non proliferative retinopathy
• ( hemorrhage, oedema, exudates
  microaneurysms and microangiopathy)
• Proliferative retinopathy
• Neovascularization and fibrosis
• ? blindness (macula )
• - Vitrous hemorrhage .
• - Cataract formation .
• - Glaucoma
• Diabetes Mellitus are more susceptible to
  infection.

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ISLET CELL TUMOURS

• Rare
• Adult
• Multiple / solitary
• May be functional
• Mainly benign / can be malignant

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ISLET CELL TUMOURS

• Three Syndromes
• 1. Hyperinsulinism hypoglycemia
• (insulinoma) of Beta cells
• solitary adenomas
• multiple
• Can be malignant

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ISLET CELL TUMOURS

• 2. Zollinger Ellison Syndrome (Gastrinoma)
• - Multiple ulcer disease
• - Gastric hypersecretion
• - Islet cell tumour
• Malignant 60 benign40
• 3.MEN (1, 2A, 2B)