Endocrine Pancreas (Hillard) Flashcards by Takara Newsome

hormone secreted in D1 pancreatic cells

vasoactive intestinal peptide; causes glycogenolysis; in high concentrations can induce watery diarrhea

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hormone secreted in pancreatic enterochromaffin cells

serotonin; regulates mood/mental states; elevated levels in carcinoid syndrome can cause facial flushing, diarrhea and tachycardia

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hormone secreted by pancreatic PP cells

pancreatic polypeptide; inhibits intestinal motility

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T1DM

5-10% of cases; adolescents and children; requires insulin

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T2DM

90-95% of cases; adults; associated with obesity

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Diagnostic criteria for DM

HbA1C >6.5% -glycated hemoglobin
fasting plasma glucose >126 mg/dL
oral glucose tolerance test > 200 mg/dL
random plasma glucose >200 mg/dL

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Genetics associated with T1DM

HLA-DR3
HLA-DR4
HLA-DQ8

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the presence of what antibodies are diagnostic for T1DM?

t cell autoimmune (type IV hypersensitivity) reaction against pancreatic beta cells; islet autoantibodies

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What is a major risk factor for T2DM?

central, visceral obesity

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Adiponectin

hormone created by fat cells; helps insulin utilization; its decrease in obesity leads to insulin resistance

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Histological finding in T2DM

amyloid deposition in pancreatic islets

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the 3 P’s in diabetes

Polyuria (osmotic diuresis)
Polydipsia (hyperosmolar)
Polyphagia (muscle and fat break down; unable to utilize glucose)

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Complications of T1DM

severe dehydration and ketoacidosis (metabolic acidosis) decreased consciousness and coma

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Lab test for DKA

test for ketones in the urine (urine nitroprusside test)
confirm w/ serum beta-hydroxybutyrate

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Complications of T2DM

Hyperosmolar Hyperglycemic Syndrome (HHS); prolonged insulin deficiency; glucose >600 mg/dL; severe dehydration; NO KETONES

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Most common cause of Maturity onset diabetes of the young (MODY)?

loss of function mutation in glucokinase in pancreatic beta cells

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Results of gestational diabetes?

large infant (macrosomia)
difficult birth (c-section)
congenital malformations
stillbirth

Pathogenesis of hyperglycemia

increased glucose leads to advanced glycation end products (AGEs) causing increased vascular damage and atherosclerosis

the 4 pathways involved in hyperglycemia

polypol pathway - loss of antioxidant protection
Hexosamine pathway - increased oxidative stress
PKC - increased GFs and procoagulant activity
AGEs - increased vascular damage and atherosclerosis

polypol pathway involvement in hyperglycemia

loss of antioxidant protection

Hexosamine pathway involvement in hyperglycemia

increased oxidative stress

activation of protein kinase C (PKC) involvement in hyperglycemia

increased GFs and procoagulant activity

advanced glycation end products (AGEs) involvement in hyperglycemia

increased vascular damage and atherosclerosis

major complications of diabetes

Macrovascular atherosclerotic disease
Retinopathy & Ocular pathology
Neuropathy
Nephropathy
Increased infection risk

the most common cause of adult-onset vision loss

Diabetic retinopathy and ocular pathology

Diabetic Peripheral Neuropathy

distal symmetric polyneuropathy; "glove and stocking" distribution numbness and loss of pain sensation

"glove and stocking" distribution numbness and loss of pain sensation

seen as a complication of Diabetic Peripheral Neuropathy; ascending process (starts distal toes and fingertips and ascends more proximal)

Foot complications to T2DM

loss of sensation can lead to diabetic foot deformity of bones and joints can lead to charcot foot - midfoot collapse "rocker-bottom" foot

Charot foot

foot complication to DM; deformity of bones and joints can lead to midfoot collapse also called "rocker-bottom" foot

Diabetic chronic kidney disease

diabetes and HTN are the most common reasons for chronic kidney disease; extremity edema and pruritis

Hyaline arteriolosclerosis

associated with chronic HTN and diabetes

Pyelonephritis in diabetes

infection of the kidneys due to increased glucose and immune dysfunction; presents with fever, chills, flank pain and hematuria; increased risk of papillary necrosis

The grade of a pancreatic neuroendocrine tumor is based on what?

mitotic index

Insulinoma

neuroendocrine tumor of pancreatic beta cells; Whipple's triad: Hypoglycemic symptoms Hypoglycemia Reversal w/ increased glucose (rapid)**

Histological feature of an insulimoa

deposition of amyloid; inappropriate high insulin during hypoglycemia can confirm diagnosis

Confirmation of an insulinoma

inappropriate high insulin during hypoglycemia can confirm diagnosis

Factitious hypoglycemia and c-peptide

hypoglycemia due to inappropriate insulin use; high insulin levels w/ low c-peptide

Zollinger-Ellison syndrome

neuroendocrine tumor that secretes gastrin; found in gastrinoma triangle (Passaro's triangle); increased gastrin leads to increased acid secretion and duodenal ulcers

What should you consider if there are multiple or unusual ulcer locations in a patient?

Gastrinoma due to MEN 1 syndrome; elevated fasting serum gastrin and gastric pH <2 (very acidic)

Glucagonoma

4D's dermatitis diabetes depression DVT

delta cell tumors

increased somatostatin; DM w/ decreased insulin, cholelithiasis and steatorrhea

VIPoma

secretory diarrhea w/ hypokalemia; increase VIP