Pathology of Endocrine Pancreas

Question 1

What is the mechanistic difference between T1 and T2 DM?

Answer 1

T1: Absolute insulin deficiency
T2: Insulin resistance with relative insulin deficiency

Question 2

What is MODY?

Answer 2

Maturity Onset Diabetes of the Young
No insulin resistence and no Ab to glutamic acid decarboxylase
NO Loss or change in B-cell numbers(T1 you DO lose B-cells)

Question 3

What is the normal range for blood glucose in a healthy person?

Answer 3

70-120 mg/dL

Question 4

What parameters define Diabetes Mellitus?

Answer 4

1) HbA1c > 6.5%
2) Fasting plasma glucose >126
3) 2-h plasma glucose >200 mg/dL in oral Glucose tolerance test
4) Random glucose reading of >200 mg/dL in Pt with classic symptoms of hyperglycemia

Question 5

What is Amylin in T2DM?

Answer 5

(Amyloid + Insulin)

Insulin abnormally packaged and secreted, accumulates outside beta cells and resembles AMYLOID

Question 6

What is the pathogenesis of T1 DM?

Answer 6

Genetic Predisposition (HLA linked genes and other genetic loci) + Environmental insult(viral molecular mimicry) + Autoimmune attack (B-Cell destruction

Question 7

What is seen microscopically in Acute insulitis?

Answer 7

Neutrophil infiltrates, degranulation and death of Beta-cells

Question 8

What is seen microscopically in Chronic insulitis?

Answer 8

Reduction in number and size of islets => loss of Beta-Cells
Lymphocyte infiltration which leads to hyalination

Question 9

What is Diabetic Microangiopathy?

Answer 9

Diffuse thickening of basement membranes in small vessels bc of hyaline formation
Vessels become MORE LEAKY!

Question 10

Where can Diabetic Microangiopathy be seen most easily?

Answer 10

Retina and renal glomeruli

Question 11

What is the most common cause of pathogenesis of complications in DM?

Answer 11

Glycation (non-enzymatic glycosylation) of Extracellular matrix)

Question 12

What are AGEs in DM?

Answer 12

Advanced glycation End Products

Question 13

What is the morphology of a Gastrinoma? (Zollinger-ellison-syndrome)

Answer 13

single mass
Usually benign
1/2 are locally invasive

Question 14

What is Diabetic Microangiopathy?

Answer 14

Diffuse thickening of basement membranes in small vessels bc of hyaline formation

Question 15

Where can Diabetic Microangiopathy be seen most easily?

Answer 15

Retina and renal glomeruli

Question 16

What is the morphology of and Insulinoma?

Answer 16

Found within the pancreas
Benign
Solitary
Small
Encapsulated
Giant Islets
10% are carcinomas

Question 17

What is the morphology of a Gastrinoma? (Zollinger-ellison-syndrome)

Answer 17

single mass

> 1/2 are locally invasive

Question 18

What is the Whipple Triad? (insulinoma

Answer 18

1) attacks of hypoglycemia when blood glucose