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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We assayed glucose tolerance and insulin secretion in ten patients with metastatic carcinoid tumors and the carcinoid syndrome ("active tumors") and in seven patients with metastatic carcinoid tumors without the carcinoid syndrome ("inactive tumors"). The patients with "active tumors" had elevated serum serotonin levels while the patients with "inactive tumors" had normal serum serotonin levels. Of the ten patients with "active tumors," five had diabetic and three had borderline intravenous glucose disposal rate constants (KG = 0.88 +/- 0.07, M. +/- S.E.M.). Their KG was significantly lower (p less than 0.01) than a group of age-matched normals. All of the patients with "inactive tumors" had normal KG values (KG = 1.67 +/- 0.24). Their KG did not differ from that of age-matched normal subjects. Both groups of carcinoid patients had a comparable decrease in their insulinogenic index. Two days' administration of the serotonin antagonist cyproheptadine (Cypro) to eight of the patients with "active tumors" resulted in a significant increase in the "insulinogenic index" (50%) but a nonsignificant increase in the KG (12%). Administration of p-chlorophenylalanine, a compound that blocks serotonin synthesis, resulted in an increase in both the KG (60%) and the "insulinogenic index" (55%). The insulin half-life (t1/2) of patients with "active tumors" (6.1 +/- 0.4 min.) did not differ from the t1/2 of normal subjects (6.6 +/- 0.4 min.), suggesting that the decreased plasma insulin levels following intravenous glucose were due to impaired insulin secretion rather than accelerated insulin destruction. Seven of the patients received treatment with the antitumor agent streptozotocin (Strepto). The patients received cumulative doses of from 70 to 300 mg. of Strepto per kilogram body weight with no impairment in glucose tolerance or insulin secretion. We conclude that there is high incidence of glucose intolerance (80%) and impaired insulin secretion in patients with the carcinoid syndrome and that serotonin plays a role in producing these alterations.
Diabetes 1975 Jul
PMID:Glucose intolerance in the carcinoid syndrome. 12 68

An umbilical nodule may be an early or late sign of metastasis from an internal location. To our knowledge, we are reporting the first case of carcinoid occuring as an umbilical mass. The occurrence in our patient of idiopathic hyperparathyroidism, diabetes mellitus, and carcinoid suggests the diagnosis of multiple endocrine adenomatosis, type I, which may result from a developmental defect in the amine and amine precursor uptake and decarboxylation cell system.
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PMID:Carcinoid in an umbilical nodule. 64 70

A case of primary pancreatic enterochromaffin cell (EC cell) carcinoid tumor in a 66-yr-old Japanese man is presented. The markedly dilated main pancreatic duct was noticed at the time of an incidental ultrasonogram during hospitalization for diabetes mellitus. Endoscopic retrograde pancreatography showed stenosis of the main pancreatic duct at the body of the pancreas and dilated pancreatic ducts distal to the obstruction. A distal pancreatectomy was performed, together with splenectomy. Macroscopically, the main pancreatic duct was compressed by a fibrous mass around the duct, and the pancreatic ducts distal to the tumor were markedly dilated. Histologically, the tumor was composed of uniform round cells, proliferating in small nests or trabeculae. The tumor cells were strongly positive with both Grimelius and Fontana-Masson stains. The immunohistochemical study disclosed the tumor cells to be positive for serotonin and chromogranin. This is a rare case of primary pancreatic EC cell carcinoid tumor with obstructive pancreatitis.
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PMID:Carcinoid tumor of the pancreas with obstructive pancreatitis. 153 73

Ninety-nine carcinoid tumors of the duodenum were studied. Seventy-seven patients were followed up for a mean period of 65 months, 20 tumors were autopsy findings, and two patients were unavailable for follow-up. Sixteen tumors (21%) produced metastases, all discovered initially; 3 patients (4%) died from metastatic disease (mean survival, 37 months postoperatively). Features associated with metastatic risk were involvement of muscularis propria, size greater than 2 cm, and the presence of mitotic figures. For 51 tumors, there was no correlation between immunohistochemical somatostatin and history of diarrhea, cholelithiasis, or diabetes mellitus (somatostatin syndrome). Five tumors were associated with Zollinger-Ellison syndrome and had immunohistochemical gastrin, but in the others there was no correlation between ulcer disease and gastrin positivity. Duodenal carcinoids are indolent, especially when small and localized to the submucosa. Immunohistochemical identification of somatostatin and gastrin has little clinical relevance.
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PMID:Carcinoid tumors of the duodenum. A clinicopathologic study of 99 cases. 169 55

In order to assess the correlation between bacteria isolated from liver abscesses and factors predisposing to liver abscesses, a retrospective study of clinical and bacteriological data on 21 patients with 27 episodes of pyogenic abscesses was carried out at the University Medical Centre, Amsterdam. Out of 27 episodes, 15 (55%) were associated with biliary or pancreatic disease; in seven of these 15 episodes more than one microorganism was cultured. Enterobacteriaceae were isolated in 13 (85%) of 15 episodes. Anaerobic bacteria were recovered only when operations in the pancreatico-biliary area had been performed previously. Seven episodes (26%) were related to extrahepatic disease; anaerobic bacteria (Bacteroides and Fusobacterium spp.) were isolated in five of these seven episodes. Streptococcus milleri seemed especially prominent, since this bacterium was cultured in six of seven episodes. Enterobacteriaceae were not involved in these seven episodes. Other factors predisposing to liver abscesses (15%) were diabetes mellitus n = 2), paraproteinaemia (n = I), and metastatic carcinoid (n = I). Blood cultures were positive in 65% of 23 episodes, but 40% of the positive cultures contained a smaller number of bacterial species than could be cultured from the abscess itself. Bacteria isolated from liver abscesses are related to the underlying predisposing condition. For diagnosis of the underlying condition and antibiotic therapy, puncture and bacteriologic examination of the abscess is essential.
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PMID:[The relationship between predisposing factors in liver abscesses and the causative bacteria]. 192 53

A case of a 29 year old man with typical picture of Cushing's syndrome is presented: pronounced hypodynamics, diabetes mellitus, hypertension, transitory psychic disorders, severe hypokalemia, metabolic alkalosis, hypercorticism, disturbed 24 h rhythm of cortisol secretion, high serum ACTH level. The treatment with steroidogenesis blockers (Metyrapone, o,p'DDD) led to a limited improvement. The well expressed organic changes in the cardiovascular and respiratory systems and pulmonary thromboembolism led to a fatal outcome. The post mortem examination revealed a pancreatic tumor 30/30 mm in size (histologically carcinoid) and enlarged hypophyseal gland with oxyphil cell hyperplasia. The electron microscopic examination found secretory granules in the pancreatic tumor cells. Concurrent ectopic secretion of ACTH by the oxyphil tumor cells is discussed.
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PMID:[Cushing's syndrome resulting from ectopic hormonal secretion]. 228 96

In this study, 92% of patients' serums known to contain antibodies against islet cells, including the Juvenile Diabetes Foundation provisional reference serum, had antibodies reacting with gastrointestinal carcinoid tumors. Twelve percent of the control serums from healthy individuals bound to carcinoid cells, and 2% bound to islet cells. Seventy-five percent of the children with newly diagnosed insulin-dependent diabetes mellitus had carcinoid tumor antibodies, and 83% had islet cell antibodies. These findings suggest that antigenic determinants are shared between endocrine cells of islets of Langerhans and neuroendocrine tumors of the same embryological derivation. Carcinoid tumors may not only provide an alternative source for islet cell antibody assays but also supply material for isolation of antigens possibly involved in the immunopathogenesis of diabetes.
Diabetes 1989 May
PMID:Antibodies against gastrointestinal carcinoid tumors in IDDM. 246 10

We report a case of a 29-yr-old man with a rectal carcinoid that metastasized to the liver, secreting somatostatin. The patient first presented with an abdominal mass and mild diabetes, and, subsequently, rectal tumor and hypersomatostatinemia. Microscopic examination of the rectal tumor showed characteristic features of carcinoid. Multiple liver metastases were recognized. The plasma level of somatostatin was remarkably high (2,839 pg/ml). Plasma gut glucagon and pancreatic polypeptide (PP) increased with progress of the disease. He died of hepatic failure 20 months after his first admission. Immunoperoxidase staining showed that rectal tumor cells contained somatostatin-like-immunoreactivity. Electron microscopy of tumor tissue showed neurosecretory (D-cell) granules. Somatostatin content of the rectal tumor was very high (5,629 pg/mg).
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PMID:Somatostatinoma of the rectum. 257 69

Octreotide is an analogue of somatostatin. Like endogenous somatostatin, it exerts a potent inhibitory effect on the release of anterior pituitary growth hormone and thyroid-stimulating hormone, and peptides of the gastroenteropancreatic endocrine system, while overcoming some of the shortcomings of exogenously administered somatostatin, namely a short duration of action, a need for intravenous administration and postinfusion rebound hypersecretion of hormone. Clinical studies have shown that octreotide is effective in the treatment of acromegaly and thyrotrophinomas. In comparative trials octreotide was significantly superior to bromocriptine in patients with acromegaly. Octreotide also appears to provide a significant advantage over existing therapies in the management of the carcinoid syndrome and offers considerable therapeutic potential in reversing carcinoid crises which may be life-threatening. Trials in patients with tumours producing vasoactive intestinal peptide demonstrated that octreotide may be an effective first-line choice for this condition, which has usually metastasised and become refractory to traditional symptomatic therapy. In limited studies in patients with high-output secretory diarrhoea, including cryptosporidium-related diarrhoea associated with AIDS and in patients with small bowel fistulas, octreotide has been shown to be effective in reducing stool/fistula output. However, well-designed clinical trials are still required to confirm its long term usefulness in these disorders. Similarly, although the use of octreotide in other conditions such as neonatal hypoglycaemia caused by nesidioblastosis, reactive pancreatitis, insulin-dependent diabetes mellitus, postprandial hypotension and the dumping syndrome has provided encouraging preliminary results, more studies are needed to clarify the place of octreotide in their treatment. Overall, octreotide appears to be well tolerated with the most frequently reported reactions being pain at the site of injection and gastrointestinal symptoms such as abdominal cramps, nausea, bloating, flatulence, diarrhoea and steatorrhoea. These adverse effects usually abate with time. Additionally, octreotide, like endogenous somatostatin, may also result in cholelithiasis, presumably by altering fat absorption and possibly by decreasing motility of the gallbladder. Thus, octreotide represents a new departure from traditional therapies in the treatment of various pathophysiological states associated with excessive peptide production and secretion. It offers a significant advantage over existing therapies in the medical management of patients with acromegaly, thyrotrophinomas, the carcinoid syndrome, tumours producing vasoactive intestinal peptide and severe secretory diarrhoea in whom conventional management options have either become exhausted or have provided suboptimal symptomatic relief.
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PMID:Octreotide. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in conditions associated with excessive peptide secretion. 268 36

Two patients with neurofibromatosis and somatostatinoma are described, one patient in addition having a parathyroid adenoma diagnosed post mortem. The other patient had a partial somatostatinoma syndrome with diabetes, abdominal pain and cholelithiasis. The tumour was diagnosed preoperatively and metabolic studies demonstrated mild diabetes mellitus apparently due to suppression of insulin secretion by somatostatin, since oral glucose tolerance returned to normal post-operatively despite hemipancreatectomy. The tumour also secreted gastrin. There are now 18 reported cases of neurofibromatosis and duodenal carcinoid tumours which makes a genuine association between these two conditions very likely. With the present two cases, seven of the carcinoid tumours in this group have been positively identified as somatostatinomas. The histological finding of psammoma bodies is important in the diagnosis of duodenal somatostatinomas.
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PMID:Neurofibromatosis associated with somatostatinoma: a report of two patients. 290 5


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