20/21: Pathology of the Endocrine Pancreas - Fang

Question 1

“bronze diabetes”

Answer 1

hemochromatosis

due to hemosiderin deposition in pancreas

Question 2

b-cell destruction leading to absolute insulin deficiency

Answer 2

type 1 DM

immune-mediated
idiopathic

Question 3

insulin resistance with relative insulin deficiency

Answer 3

type 2 DM

Question 4

MODY =

Answer 4

maturity onset diabetes of the young

genetic abnormalities which cause a primary defect in b-cell function

Question 5

no obesity
no insulin resistance
no antibodies to gluatmic acid

Answer 5

MODY

-just a defect in b-cell function

Question 6

normal blood glucose range

Answer 6

70-120

Question 7

any one of four criteria for diabetes diagnosis :

Answer 7

1. A1c greater of equal to 6.5%
2. Fasting plasma glucose greater than 126 mg/dL
3. 2h plasma glucose greater than 200 mg/dL during an oral glucose tolerance test
4. random glucose greater than 200 in patient with symptoms

• in the absence of unequivocal hyperglycemia, criteria 1-3 should be confirmed

Question 8

most common COD in pt with DM

Answer 8

MI

Question 9

inflammation, degranulation of b-cells, and death of b-cells

Answer 9

acute islitis
early change in type I DM

following this acute inflammation, there will eventually be a reduction in number and size of islets; thus loss of b-cells. later will be hyalinized.

Question 10

there is a _______ lack of insulin in type 2 DM

Answer 10

relative

normal levels of insulin re circulating but cells are not appropriately responding to the insulin

Question 11

primary beta cell defect and peripheral tissue insulin resistance –> hyperglycemia —> _______ —> type 2 DM

Answer 11

beta cell exhaustion

Question 12

insulin, abnormally packaged and secreted, accumulating outside beta cells

Answer 12

amylin (because resembles amyloid)

sign of type 2 DM

Question 13

does early type 2 DM show insulinitis?

Answer 13

no insulinitis present

Question 14

“glucose toxicity”

Answer 14

later stage of Type 2 DM

mild/moderate insulin deficency due to beta cell damage/exhaustion due to chronic hyperglycemia

Question 15

amorphous “cracked plate glass”

Answer 15

histological type II DM

amylin

Question 16

***_____________ is the MOST common underlying cause in the pathogenesis of complications in DM

Answer 16

non-enzymatic glycosylation of extracellular matrix

Question 17

4 pathogenic effects of AGEs

Answer 17

1. plasma prtns can bind to glycated BM
2. can induce cross linking in type IV collagen in BM
3. can trap LDL particles in artery walls
4. can bind to receptors on numerous cell types

Question 18

AGEs =

Answer 18

advanced glycation end-products

Question 19

AGEs binding to cell receptors can cause (4)

Answer 19

• release of cytokines and growth factors from macrophages
• increased endothelial permeability
• increased endothelial procoagulant activity
• increased extracellular matrix production by vascular smooth muscle cells as well as increased proliferation

Question 20

AGEs play a role in damage of BM by (2)

Answer 20

• prtn accumulation thickening of BM

- trapping of LDL in artery wall, oxidation

Question 21

most consistent morphologic feature of diabetes

Answer 21

diffuse thickening of BM

most evident in capillaries of retina and renal glomeruli

Question 22

despite increase in thickness of BM, diabetic capillaries are _______ than normal to plasma prtns

Answer 22

more leaky

Question 23

microangiopathy underlies the development of …

Answer 23

diabetic nephropathy
diabetic retinopathy
some forms of neuropathy

Question 24

thick, narrow, and leaky SMALL blood vessels

Answer 24

diabetic microangiopathy- especially in kidneys and eyes

due to glycosylation
BM damage leak
AGE deposition

Question 25

how would you describe peripheral neuropathy caused by DM nerve damage?

Answer 25

symmetric , bilateral
progressive, irreversible
paraesthesia
pain
muscle atrophy

Question 26

damage to blood vessels in eyes is described as

Answer 26

exudative and proliferative retinopathy

Question 27

diabetic nephrosclerosis =

Answer 27

nodular kimmelstiel-wilson glomerulopathy

Question 28

gram negative bacilli –>

staphylocci –>

Answer 28

pyelonephritis

cortical infection

Question 29

what are some effects of visceral neuropathy?

Answer 29

CN - diplopia, bell palsy
GIT - constipation, diarrhea
CVS- orthostatic hypotension

Question 30

diabetic macroangiopathy =

Answer 30

accelerated atherosclerosis

due to nonenzymatic glycosylation of lipoprtns

Question 31

ischemia due to microangiopathy and atherosceleroiss serves as a stimulus for neovascular proliferation

Answer 31

diabetic retinopathy

Question 32

3 changes in retina with diabetic retinopathy

Answer 32

edema
hemorrhagic foci
neovascularization

Question 33

no insulinitis

yes amyoid

Answer 33

type 2 DM

Question 34

more concordance in twins

Answer 34

type 2 DM

Question 35

2 pancreatic neuroendocrine tumors NETs

Answer 35

• insulinoma
• zollinger-ellison syndrome
• wermer syndrome

Question 36

hyperinsulinism NET

Answer 36

insulinoma

most common pancreatic NET

Question 37

hypergastrinemia NET

Answer 37

zollinger-ellison syndrome

Question 38

MEN1 syndrome NET

Answer 38

wermer syndrome

Question 39

**Whipple triad of hypoglycemia

Answer 39

• blood glucose less than 45 mg/dL
• CNS confusion/stupor
• precipitated by fasting or exercise and relieved by food

Question 40

describe insulinomas

Answer 40

• benign
• solitary
• small
• encapsulated
• “giant islets”
• amyloid can be found
• 10% carcinomas

Question 41

multiple peptic ulcerations in stomach, duodenum and even jejunum —>

Answer 41

suspect zollinger-ellison syndrome

result of elevated gastric acid secretion caused by a gastrinoma

Question 42

risks of zollinger-ellison syndrome

Answer 42

• 1/2 metastasized at time of diagnosis

- 25% associated with other endocrine tumors (MEN1 syndrome)