15.9 Endocrine Pancreas

Question 1

The endocrine pancreas is composed of clusters of cells termed

Answer 1

islets of langerhans

Question 2

insulin is secreted by

Answer 2

beta cells

Question 3

beta cells are located

Answer 3

in the center of the islet

Question 4

major anabolic hormone

Answer 4

insulin

Question 5

insulin upregulates WHAT on adipocytes and skeletal muscle cells

Answer 5

GLUT4 (glucose-dependent transporter)

Question 6

GLUT4 is on what cells?

Answer 6

adipocytes and skeletal muscle

Question 7

insulin –> increased glucose uptake –>

Answer 7

increased glycogen synthesis, protein synthesis, and lipogenesis

Question 8

major catabolic hormone

Answer 8

glucagon

Question 9

glucagon is secreted by

Answer 9

alpha cells

Question 10

in states of fasting, glucagon increases blood glucose via

Answer 10

glycogenolysis

lipolysis

Question 11

insulin deficiency due to autoimmune destruction of beta cells by T cells

Answer 11

type 1 DM

Question 12

histology of type 1 DM

Answer 12

inflammation fo islets

Question 13

Type 1 DM genetic association?

Answer 13

HLA-DR3 and HLA-DR4

Question 14

clinical features of insulin deficiency

Answer 14

weight loss, low muscle mass, polyphagia, polyuria, polydipsia;

Question 15

DM1 labs

Answer 15

hyperglycemia glucosuria

Question 16

dm1 treatment

Answer 16

lifelong insulin

Question 17

why does diabetic ketoacidosis often arise with stress (infection) in dm1?

Answer 17

Epinephrine stimulates glucagon secretion –> lipolysis –> FFAs –> ketones

Question 18

name two ketones

Answer 18

beta-hydroxybutryric acid and acetoacetic acid

Question 19

DKA labs

Answer 19

hyperglycemia (> 300)
anion gap metabolic acidosis
hyperkalemia

Question 20

presentation of DKA

Answer 20

Kussmaul respirations,
dehydration, 
nausea/vomiting,
mental status changes,
fruity smelling breath (due to acetone)

Question 21

DKA treatment

Answer 21

1. fluids
2. insulin
3. electrolytes (potassium)

Question 22

end-organ insulin resistance leading to a metabolic disorder characterized by hyperglycemia

Answer 22

DMT2

Question 23

what percent of DM is type II?

Answer 23

90%

Question 24

what percent of US pop has dmt2?

Answer 24

5-10%

Question 25

why is dmt2 associated with obesity?

Answer 25

decreased #s of insulin receptors

Question 26

amyloid deposition in the islets

Answer 26

histology of dmt2

Question 27

insulin levels early in dmt2?

Answer 27

high

Question 28

why does insulin deficiency develop later in dmt2?

Answer 28

beta cell exhaustion

Question 29

clinical features of dmt2

Answer 29

polyuria, polydipsia, hyperglycemia (often silent though)

Question 30

diagnosis of dmt2

Answer 30

1. random glucose > 200 2. fasting glucose > 126 3. glucose tolerance test > 200 after glucose loading

Question 31

dmt2 treatment

Answer 31

1. weight loss (diet and exercise) 2. sulfonylureas or metformin 3. exogenous insulin

Question 32

dmt2 --> risk for [emergent complication]

Answer 32

hyperosmolar non-ketotic coma

Question 33

hyperosmolar non-ketotic coma mechanism?

Answer 33

high glucose (> 500) --> life-threatening diuresis --> hypotension --> coma (nb: no ketones)

Question 34

NEG of large and medium sized vessels leads to

Answer 34

atherosclerosis (cvd + peripheral vascular dz)

Question 35

what is the leading cause of death among diabetics?

Answer 35

cvd

Question 36

what is the leading cause of non traumatic amputations

Answer 36

peripheral vascular dz

Question 37

NEG of small vessels -->

Answer 37

hyaline arteriolsclerosis

Question 38

NEG of renal arterioles -->

Answer 38

glomerulosclerosis --> small scarred kidneys with a granular surgace

Question 39

preferential hyaline arteriosclerosis of efferent arterioles -->

Answer 39

high GFR --> hyper filtration injury (microabuminuria) --> nephrotic syndrome

Question 40

histology of diabetic nephrotic syndrome

Answer 40

kimmelstiel-wilson nodules

Question 41

NEF of hemoglobin -->

Answer 41

HbA1c

Question 42

what is the leading cause of blindness in the developed world?

Answer 42

diabetes

Question 43

what do schwann cells do?

Answer 43

myelinate peipheral nervels

Question 44

into what cells does glucose freely enter (causing osmotic damage in diabetes)?

Answer 44

schwann cells, pericytes of retinal vessels, lens

Question 45

intracellularly, what converts glucose to sorbitol --> osmotic damage?

Answer 45

aldose reductase

Question 46

intracellularly, aldose reductase converts glucose to WHAT, causing osmotic damage

Answer 46

sorbitol

Question 47

osmotic damage in diabetes -->

Answer 47

peripheral neuropathy, impotence, blinddness, cataracts

Question 48

pancreatic endocrine neoplasms should make you think

Answer 48

MEN1

Question 49

MEN1

Answer 49

parathryoid hyperplasia pituitary adenoma pancreatic endocrine neoplasm

Question 50

episodic hypoglycemia with mental status changes that are relieved by administration of glucose

Answer 50

insulinoma

Question 51

how would you diagnose insulinoma

Answer 51

decreased serum glucose (<50) | increased insulin + c-peptide

Question 52

what other things could look like insulinoma?

Answer 52

exogenous insulin admin (but c-peptide not raised) | sulfonylurea or melitinide abuse

Question 53

treatment-resistnace peptic ulcers; ulcers may be multiple and extend into jejunum

Answer 53

Zollinger-Ellison syndrome (gastrinoma)

Question 54

achlorhydria (due to inhibition of gastrin) and cholelithiasis with steatorrhea (inhibitor of cholecystokinin)

Answer 54

somatostatinoma

Question 55

watery diarrhea, hypokalemia, achlohydria

Answer 55

VIPoma

Question 56

DM, necrolytic erythrema, anemia

Answer 56

glucagonoma