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Rosalynn's ABSITE > Endocrine pancreas syndromes > Flashcards

Endocrine pancreas syndromes Flashcards

1
Q

Are PNETs more commonly functional or non functional?

A

non functional

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2
Q

what percent of PNETs are malignant?

A

75%

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3
Q

where is the MC site of mets for PNETs?

A

liver

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4
Q

what is octreotide useful for?

A

effective for symptoms with insulinoma, gastronome, glucagonoma, VIPoma

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5
Q

Most common PNETs in the head of the pancreas?

A

gastronome, somatostatinoma

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6
Q

which PNETs should have cholecystectomy?

A

glucagonoma and VIPoma to avoid gallstones with prolonged octreotide use. Also use for somatostatinoma for mets use

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7
Q

what is the MC functional PNET?

A

insulinoma

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8
Q

what is the Whipple triad? (for insulinoma)

A

fasting hypoglycemia (<55), symptoms of hypoglycemia (confusion, LOC, seizures, increase HR, diaphoresis), relief with glucose admin

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9
Q

are most insulinomas malignant or benign?

A

benign

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10
Q

where are insulinomas found

A

throughout the pancreas

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11
Q

If insulin and C peptide are not elevated after 72 hr fast, what would you suspect?

A

Manchausen’s syndrome

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12
Q

what imaging localizes the insulinoma?

A

triple phase CT (or MRI) and EUS

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13
Q

If cannot locate insulinoma with CT or MRI or EUS what is the next step?

A

selective intra-arterial calcium injection with hepatic venous sampling for insulin

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14
Q

which PNET is somatostatin scintigraphy not helpful for?

A

insulinoma

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15
Q

what is the treatment for insulinoma

A

enucleate if <2 cm or formal resection if >2 cm

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16
Q

what is the treatment for insulinoma with mets?

A

5FU and streptozocin, octreotide

Diazoxide for symptoms

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17
Q

are gastrinomas more commonly spontaneous or from MEN 1?

A

spontaneous

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18
Q

what percent of gastrinomas are found in the triangle?

A

75%

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19
Q

what is a tip off to gastrinomas?

A

ulcers past 1st portion of duodenum

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20
Q

what are the tests for gastrinomas?

A

fasting gastrin >1000 is diagnostic, secretin test (positive will have decreased gastrin, normal will have increased gastrin)

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21
Q

what is the best imaging for gastrinomas?

A

somatostatin scintigraphy (get second if not found on CT or MRI)

22
Q

what is the first imaging for PNETs?

A

CT triple phase or MRI

23
Q

what is the treatment for gastrinomas?

A

enucleation (<2 cm), formal resection with lymph nodes (>2 cm)

24
Q

what is the treatment for metastatic gastrinomas?

A

50% of pts. focus on symptom control

25
Q

what are the symptoms of glucagonoma?

A

4D’s: diabetes, dermatitis (necrolytic migratory erythema), depression, DVT, weight loss

26
Q

mostly malignant PNET

A

glucagonoma, 90% (distal pancreas)

27
Q

treatment for glucagonoma

A

formal resection w/regional lymph node dissection for all (high malignancy rate) + cholecystectomy

28
Q

what can you give to help the rash with glucagonomas?

A

zinc, amino acids, fatty acids

29
Q

what are the symptoms with VIPoma

A

watery diarrhea, hypokalemia, achlorhydria (WDHA)

30
Q

are VIPomas mostly benign or malignant?

A

malignant

31
Q

where are VIPomas found usually

A

distal pancreas

32
Q

what is the treatment for VIPomas

A

formal resection with lymph node dissection + cholecystectomy

33
Q

What are the symptoms of somatostatinoma?

A

diabetes, gallstones, steatorrhea

34
Q

how do you dx somatostatinoma?

A

fasting somatostatin level

35
Q

are somatostatinomas mostly benign or malignant?

A

malignant

36
Q

what is the treatment for somatostatinomas?

A

formal resection with lymph node dissection + cholecystectomy

37
Q

glucagon is made where

A

alpha cells

38
Q

insulin is made where

A

beta cells (at center of islets)

39
Q

somatostatin is made where

A

D cells

40
Q

pancreatic polypeptide is made where

A

PP or F cells

41
Q

VIP and serotonin are made where

A

islet cells

42
Q

what does enterokinase do

A

released by duodenum and activates trypsinogen to trypsin

43
Q

what does trypsin do

A

activates other pancreatic enzymes including trypsinogen

44
Q

what does secretin do

A

increase HCO3 mostly

45
Q

what does CCK do?

A

increase pancreatic enzymes

46
Q

what does acetylcholine do

A

increase HCO3 and enzymes

47
Q

what does somatostatin and glucagon do

A

decrease exocrine function

48
Q

where does CCK and secretin come from

A

most released by cells in duodenum

49
Q

what is the affect of CCK and glucagon on the sphincter of Oddi?

A

relaxes the sphincter

50
Q

what are the exocrine enzymes of the pancreas?

A

amylase, lipase, trypsinogen, chymotrypsinogen, carboxypeptidase, HCO3

51
Q

what is the only pancreatic enzyme that is released in its active form?

A

amylase - hydrolyzes alpha 1-4 linkages of glucose chains

Rosalynn's ABSITE (33 decks)

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