pancreatic neuroendocrine tumors

Question 1

what causes high production of insulin lead to hypoglycemia

Answer 1

insulinoma

Question 2

whipple triad in insulinoma

Answer 2

o Hypoglycemia (< 2.8 mmol/L)
o Symptoms of hypoglycemia with fasting
o Symptoms resolve with administering glucose (after eating)

Question 3

is insulinoma beingn

Answer 3

90% are benign

Question 4

diagnosed by what insulinoma

Answer 4

o Increased fasting insulin
o Increased c-peptide – used to differentiate from exogenous insulin
administration
o Insulin:glucose ratio > 0.3

Question 5

Overproduction of gastrin, Tumor is small, slow growing, multiple and 60% malignant

Answer 5

Gastrinoma: Zollinger-Ellison syndrome

Question 6

loaction of gastrinoma

Answer 6

o 70% are in the duodenum (gastrinoma triangle)
o 25% are in the pancreas

Question 7

presentation of gastrinoma

Answer 7

o Abdominal pain that is worse after eating
o Reflux
o PUD: Ulcers are large (> 1-2 cm), multiple, recurrent and in the distal
duodenum
o Diarrhea is profuse and watery because acid inactivates lipase

Question 8

how many percent in gastrinoma associated witg MEN1

Answer 8

50%

Question 9

how is gastrinoma diagnosed

Answer 9

o High fasting gastrin levels
o Secretin stimulation test shows increased paradoxical increase in gastrin
o Increased gastric acidity and gastric output

Question 10

what is VIPoma: Verner-Morrison syndrome or WDHA

Answer 10

Overproduction of VIP (vasoactive intestinal peptide)

• WDHA = watery – diarrhea – hypokalemia - achlorhydria

Question 11

where is most of VIPoma localized

Answer 11

90% pancreas

Question 12

is VIPoma malignant

Answer 12

Patients present with severe watery diarrhea and sign of hypokalemia.

• Most cases are malignant and already metastasized to lymph nodes at time of diagnosis

• Patients have increased fasting VIP levels

Question 13

glucagonoma

Answer 13

Presentation: 4 Ds:
o Diabetes
o Dermatitis: necrolytic migratory erythema (red psoriatic-like rash with serpiginous borders over the trunk and legs)
o DVT
o Depression
o Patients also present with weight loss (low AA), mucositis and anemia

Question 14

somatostatinoma inhibits what by the inhibitory hormone somatostatin

Answer 14

o Pancreatic secretions = malabsorption + steatohrrea
o Biliary contraction= gallstones
o Intestinal secretions
o inhibit insulin= high glucose
o inhibit glucagon + gastrin= dec gastric secretion