15.9 Endocrine Pancreas Flashcards
What cells produce insulin?
Beta Cells - they lie in the center of the islets
Type I Diabetes Mellitus
Insulin deficiency leading to a metabolic disorder of hyperglyc
What is the cause of Type I DM?
Autoimmune destruction of beta cells by T-cells causing inflammation of the islets
What genes are associated with Type I DM?
HLA-DR3 and DR4
What Ab can patients with Type I DM have?
Anti-insulin Ab
What are the clinical manifestations of Type I DM?
- Manifests in childhood
- High glucose
- Weight loss
- Low muscle mass
- Polyphagia
- Polyuria
- Polydipsia
What is the treatment for Type I DM?
Lifelong insulin
What are Type I DM patients at risk for?
Diabetic Ketoacidosis
What are the clinical features of diabetic ketoacidosis?
- Hyperglycemia
- Anion gap metabolic acidosis
- Hyperkalemia
- Kussmaul respirations
- Fruity breath
- Mental status changes
Type II Diabetes Mellitus
End organ insulin resistance that leads to hyperglycemia
What is the classic patient of Type II DM?
Middle-aged obese adult
How does obesity link to diabetes?
Obesity decreases the number of insulin receptors
What will be found within the islets in the pancreas as the beta cells exhaust in Type II DM?
Amyloid depositon
What are the clinical features of Type II DM?
- Polyuria
- Polydipsia
- Hyperglycemia
What are the treatments for Type II DM?
- Weight loss
- Insulin
What is Type II DM a risk for?
Hyperosmolar Non-ketotic Coma
Hyperosmolar Non-ketotic Coma
High glucose levels of greater than 500 mg/dL leads to life threatening diuresis with hypotension and coma
-NO KETONES
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.
Non-enzymatic Glycosylation
How are the Schwann cells damaged in diabetes?
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
What converts glucose to sorbitol?
Aldose Reductase
What are the components of the MEN1 gene?
- Parathyroid Hyperplasia
- Pituitary Adenoma
- Pancreatic Endocrine Tumor
Pancreatic Endocrine Tumor
Tumors of islet cells
Insulinoma
Tumors that produce insulin that cause episodic hypoglycemia with mental status changes
What will lab findings show in insulinoma?
- Decreased glucose
- Increased insulin
- Increased C-peptide
Gastrinoma
Treatment resistant peptic ulcers due to ZE syndrome due to excess acid production - there can be multiple that extend to the jejunum
Somatostatinoma
- Achlorhydria (inhibits Gastrin)
- Cholelithiasis and Steatorrhea (inhibits CCK)
VIPoma
- Watery diarrhea
- Hypokalemia
- Achlorhydria
