15.9 Endocrine Pancreas

Question 1

What cells produce insulin?

Answer 1

Beta Cells - they lie in the center of the islets

Question 2

Type I Diabetes Mellitus

Answer 2

Insulin deficiency leading to a metabolic disorder of hyperglyc

Question 3

What is the cause of Type I DM?

Answer 3

Autoimmune destruction of beta cells by T-cells causing inflammation of the islets

Question 4

What genes are associated with Type I DM?

Answer 4

HLA-DR3 and DR4

Question 5

What Ab can patients with Type I DM have?

Answer 5

Anti-insulin Ab

Question 6

What are the clinical manifestations of Type I DM?

Answer 6

• Manifests in childhood
• High glucose
• Weight loss
• Low muscle mass
• Polyphagia
• Polyuria
• Polydipsia

Question 7

What is the treatment for Type I DM?

Answer 7

Lifelong insulin

Question 8

What are Type I DM patients at risk for?

Answer 8

Diabetic Ketoacidosis

Question 9

What are the clinical features of diabetic ketoacidosis?

Answer 9

• Hyperglycemia
• Anion gap metabolic acidosis
• Hyperkalemia
• Kussmaul respirations
• Fruity breath
• Mental status changes

Question 10

Type II Diabetes Mellitus

Answer 10

End organ insulin resistance that leads to hyperglycemia

Question 11

What is the classic patient of Type II DM?

Answer 11

Middle-aged obese adult

Question 12

How does obesity link to diabetes?

Answer 12

Obesity decreases the number of insulin receptors

Question 13

What will be found within the islets in the pancreas as the beta cells exhaust in Type II DM?

Answer 13

Amyloid depositon

Question 14

What are the clinical features of Type II DM?

Answer 14

• Polyuria
• Polydipsia
• Hyperglycemia

Question 15

What are the treatments for Type II DM?

Answer 15

• Weight loss

- Insulin

Question 16

What is Type II DM a risk for?

Answer 16

Hyperosmolar Non-ketotic Coma

Question 17

Hyperosmolar Non-ketotic Coma

Answer 17

High glucose levels of greater than 500 mg/dL leads to life threatening diuresis with hypotension and coma

-NO KETONES

Question 18

A complication of diabetes that can lead to atherosclerosis in large/medium vessels and hyaline arteriolosclerosis in small vessel. NEG of Hb leads to formation of HbA-1c.

Answer 18

Non-enzymatic Glycosylation

Question 19

How are the Schwann cells damaged in diabetes?

Answer 19

They can take up glucose without the need for insulin and high glucose in these cells is converted to sorbitol which leads to damage of the cell -> NEUROPATHY

Question 20

What converts glucose to sorbitol?

Answer 20

Aldose Reductase

Question 21

What are the components of the MEN1 gene?

Answer 21

• Parathyroid Hyperplasia
• Pituitary Adenoma
• Pancreatic Endocrine Tumor

Question 22

Pancreatic Endocrine Tumor

Answer 22

Tumors of islet cells

Question 23

Insulinoma

Answer 23

Tumors that produce insulin that cause episodic hypoglycemia with mental status changes

Question 24

What will lab findings show in insulinoma?

Answer 24

• Decreased glucose
• Increased insulin
• Increased C-peptide

Question 25

Gastrinoma

Answer 25

Treatment resistant peptic ulcers due to ZE syndrome due to excess acid production - there can be multiple that extend to the jejunum

Question 26

Somatostatinoma

Answer 26

• Achlorhydria (inhibits Gastrin)

- Cholelithiasis and Steatorrhea (inhibits CCK)

Question 27

VIPoma

Answer 27

• Watery diarrhea
• Hypokalemia
• Achlorhydria