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

This article describes the visualization of a pancreatic somatostatinoma and liver metastases using 111In-pentetreotide imaging in a patient with somatostatinoma syndrome. A 61-yr-old woman with gallbladder stones, diabetes, weight loss, diarrhea and steatorrhea, immunohistochemical diagnosis of somatostatinoma (liver biopsy) and high plasma values of somatostatin was studied by somatostatin receptor scintigraphy. Six sites of focal abnormal 111In-pentetreotide hyperfixation were found: three in the liver and three in the pancreatic area. This case report demonstrates that in vivo detection of somatostatinoma with somatostatin receptor imaging is possible in the presence of high levels of circulating somatostatin, suggesting that receptor downregulation has not occurred.
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PMID:Somatostatin receptor scintigraphy of malignant somatostatinoma with indium-111-pentetreotide. 918 35

The aim of our study was to analyze the influence of alcohol consumption on the early clinical manifestations of alcoholic chronic pancreatitis of the 517 patients in whom chronic pancreatitis was initially suspected, 158 were diagnosed with this disease; of these, alcohol was considered the cause in 136 (86.1%). Alcohol was considered a major etiologic factor when mean consumption was > or = 60 grams per day for at least 4 years. Alcohol consumption, initial clinical manifestations and time of onset were considered up until the moment of diagnosis in all patients. The sex distribution was 133 men (97.8%) and 3 women (2.2%). The average age was 22 +/- 6.5 years at onset of alcoholism, 38 +/- 9.4 years at onset of clinical features, and 44 +/- 9.4 years at diagnosis. The interval between the onset of alcoholism and the initial clinical manifestations was 15.8 +/- 8.8 years, and the interval between the latter and diagnosis was 6.1 +/- 4.9 years. Average alcohol consumption was 162 +/- 8 grams/day and total consumption was 1312 +/- 1017 kg. A statistically significant relationship was found only for mean alcohol consumption and abdominal pain. We found a higher frequency of acute pancreatitis outbreaks, calcifications, steatorrhea and diabetes until the moment of diagnosis in the higher alcohol consumption groups, although the relationship was not statistically significant.
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PMID:Influence of alcohol consumption on the initial development of chronic pancreatitis. 942 5

Pancreatic steatorrhea and pancreatic diabetes are the dominant symptoms of patients in the decompensated stage of chronic pancreatitis (CP). In this stage, the nutritional state is greatly disturbed and hypoglycemia and labile infection are involved. Pancreatic enzyme replacement therapy is the principal treatment method for pancreatic steatorrhea. Before initiating this therapy, dietary fat intake must be determined and pancreatic lipase and bicarbonate secretion function must be evaluated. Upper small intestinal pH is regulated by gastric acid secretion, and abnormal gastric emptying changes lipolysis. In addition, precipitation of bile acids in the upper small intestine and ileal brakes due to undigested fats and carbohydrates must be considered. Porcine pancreatin, bacterial lipase, and acid-resistant fungal lipase are used as enzymes for replacement therapy. Conventional, entero-coating, and enteric-coated microsphere preparations of porcine pancreatin are available for treatment and are formulated to protect against gastric acids, to dissolve enzymes at optimum pH, and to be emptied simultaneously with food from the stomach. Gastric acid secretion suppressants, such as H2 blockers or a proton pump inhibitor, can also be used concomitantly with pancreatin preparations. In consideration of both strengths and weaknesses of these preparations, types and dosages of enzyme replacement therapy should be carefully prescribed, and fecal fats should be examined repeatedly by a simple and rapid method during treatment. Attention should also be paid to changes in body weight and nutritional indices (e.g., nutritional parameters, fat-soluble vitamins). The relationship between carbohydrate maldigestion/malabsorption in CP patients and treatment of pancreatic diabetes are topics for future research.
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PMID:Pancreatic dysfunction and treatment options. 954 75

The conservative medical treatment of chronic pancreatitis entails dealing prevalently with exocrine and endocrine insufficiency, diet and pain. As steatorrhoea can cause malabsorption, it is advisable to reduce first the fat content of the diet and secondly to prescribe, where necessary, pancreatic enzymes. Several factors can lead to a poor therapeutic enzyme effect. Attention should be given to the pharmacological properties of the enzyme-preparation and to the secretion of acid in the stomach. An endocrine insufficiency is more difficult to treat compared to a classical diabetes mellitus, for lack of endocrine regulatory mechanisms. Pain is the consequence of several pathophysiological processes. Before initiating analgetic treatment, a minimal diagnostic program should be completed allowing the exclusion of those primary causes of pain which require an alternative approach such as interventional endoscopy or surgery.
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PMID:[Conservative medical treatment of chronic pancreatitis]. 963 24

Fibrocalculous pancreatic diabetes (FCPD) is a unique form of diabetes secondary to chronic pancreatitis seen in developing countries of the world associated with either overt protein-calorie malnutrition or, more likely, with deficiency of certain micronutrients. FCPD affects young individuals and runs an aggressive course to reach the endpoints of diabetes, pancreatic calculi and exocrine pancreatic dysfunction (steatorrhoea) in the majority of cases. There are characteristic features of FCPD radiologically, ultrasonographically, on endoscopic retrograde cholangiopancreatography and on histopathology which distinguish it from chronic pancreatitis of other aetiologies seen in temperate zones, e.g. alcoholic chronic pancreatitis. Although a secondary form of diabetes, specific diabetes-related complications like retinopathy and nephropathy do occur in FCPD. There appears to be a high risk of developing pancreatic carcinoma. Although the aetiology of FCPD is still unclear, the role of micronutrient (antioxidant) deficiency is emerging as a possible aetiological or predisposing factor. The contribution of genetic factors and environmental toxins, e.g. cyanogenic glycosides or other nutritional/toxic factors, merit further study. Studies on FCPD, a good model of a secondary form of diabetes, could lead to improved understanding of other primary forms of diabetes as well. If the underlying aetiological factors are identified, it may also be possible to prevent this type of diabetes.
Diabetes Metab Rev 1998 Jun
PMID:Fibrocalculous pancreatic diabetes. 967 68

Chronic pancreatitis is typically characterized by clinical (abdominal pain, steatorrhea, loss of body weight), morphological (calcifications, dilated ductus pancreaticus) as well as functional (maldigestion, diabetes mellitus) parameters. Since the diagnosis of chronic pancreatitis is hampered by the inavailability of early histological confirmation, it is therefore based on morphological (ultrasound, ERP, EUS, CT) and functional (faecal elastase) criteria. Due to the poor correlation between morphological and functional parameters in the early phase of the disease, both are complementary at this stage. While the diagnosis of severe cases of chronic pancreatitis with steatorrhea is hardly a challenge in clinical practice, the differential diagnostic evaluation of mild and moderate cases remains a major clinical problem. ERP remains to be the most sensitive morphological procedure, while determination of faecal elastase is the most sensitive and specific "tubeless" pancreatic function test available today and in the future prove to be rapid, easy to handle and highly practicable in clinical routine.
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PMID:[Diagnosis of chronic pancreatitis]. 985 66

In order to clarify whether there is a negative feedback mechanism for CCK secretion, we investigated plasma CCK bioactivity in patients suffering from chronic pancreatitis (CP) according to the characteristics of their pancreatic disease. Basal, meal-stimulated, and integrated release of plasma cholecystokinin (CCK) bioactivity was measured in 24 patients with CP and in 12 healthy controls. The values obtained were compared between the healthy control group and the CP group, and between subgroups of CP patients established on the basis of the presence/absence of several parameters: abnormal gastric emptying, abdominal pain, steatorrhea, pancreatic calcification, insulin-requiring diabetes mellitus, and impairment of pancreatic exocrine functions as indicated by secretin test. A bioassay method using pancreatic acini was used to measure plasma CCK bioactivity. In the control group, plasma CCK bioactivity increased from a basal value of 1.6 +/- 0.7 pmol/L to a maximal increase of 6.6 +/- 4.1 pmol/L, and the integrated CCK release following a test meal was 37.7 +/- 19.3 pmol/L.150 min. In the CP group, plasma CCK bioactivity increased from 1.6 +/- 0.9 pmol/L to a maximal increase of 8.2 +/- 8.7 pmol/L, and the integrated release of CCK was 43.0 +/- 37.7 pmol/L.150 min. None of the differences between them were significant. No significant differences in basal value, maximal increase, or integrated plasma CCK release were noted according to any of the parameters of the CP patients and the control group. Nor was there any correlation between impairment of pancreatic exocrine function and plasma CCK bioactivity. These results provide no evidence of a negative feedback mechanism between pancreatic exocrine dysfunction and CCK secretion.
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PMID:Meal-related changes in plasma CCK bioactivity in patients with chronic pancreatitis. 992 89

Celiac disease is a permanent intolerance to ingested gluten that results in immunologically mediated inflammatory damage to the small-intestinal mucosa. Celiac disease is associated with both human leukocyte antigen (HLA) and non-HLA genes and with other immune disorders, notably juvenile diabetes and thyroid disease. The classic sprue syndrome of steatorrhea and malnutrition coupled with multiple deficiency states may be less common than more subtle and often monosymptomatic presentations of the disease. Diverse problems such as dental anomalies, short stature, osteopenic bone disease, lactose intolerance, infertility, and nonspecific abdominal pain among many others may be the only manifestations of celiac disease. The rate at which celiac disease is diagnosed depends on the level of suspicion for the disease. Although diagnosis relies on intestinal biopsy findings, serologic tests are useful as screening tools and as an adjunct to diagnosis. The treatment of celiac disease is lifelong avoidance of dietary gluten. Gluten-free diets are now readily achievable with appropriate professional instruction and community support. Both benign and malignant complications of celiac disease occur but these can often be avoided by early diagnosis and compliance with a gluten-free diet.
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PMID:The widening spectrum of celiac disease. 1007 17

The salivary glands are structurally similar to the exocrine pancreas and may be involved in the course of diseases of autoimmune origin (sclerosing cholangitis, ulcerative rectocolitis, primary biliary cirrhosis). For a not-yet-quantified proportion of chronic pancreatitis (CP) cases, a possible autoimmune pathogenesis has been postulated. The aim of the study was to assess the frequency of salivary ductal system abnormalities in patients with CP. Fifty-one patients with CP consecutively admitted to our center were studied (44 men, seven women; mean age, 48.2 +/- 10.8 years). The mean duration of disease was 11.7 years (range, 1-37 years); 44 (86%) of 51 patients had pancreatic calcifications, 25 (49%) of 51 diabetes, 25 (52%) of 48 steatorrhea, and 32 (63%) of 51 underwent pancreatic surgery. As a control group, we studied 10 patients of whom four with liver cirrhosis (three alcoholic and one posthepatitis; three men, one woman; mean age, 57 +/- 12.5 years), and six with temporomandibular pain (five men and one woman; mean age, 42 +/- 10.3 years). The patients were given parotid sialography, the findings being read by two independent observers. In two CP patients, parotid sialography was unsuccessful. Fifteen (31 %) of 49 patients and none of the 10 control patients exhibited abnormalities of the glandular ducts compatible with chronic inflammation of the salivary ducts (p = 0.039). None of the CP patients had salivary intraductal calcifications. Findings of parotid ductal abnormalities are frequent in the course of CP and may indicate a common pathogenetic mechanism, even of an immune type.
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PMID:Salivary gland involvement in patients with chronic pancreatitis. 1041 89

Glucagonoma and somatostatinoma are tumors which produce the respective hormone. When these peptides are also secreted into the circulation the clinical syndromes are characterized by the signs and symptoms due to hormone overproduction. In case of the glucagonoma-syndrome diabetes and typical skin lesions are dominating while patients with the somatostatinoma syndrome have diabetes frequently associated with steatorrhea. Surgical resection of the tumor and its metastases as far as possible is the therapy of choice. For symptomatic relief and inhibition of the growth of the metastases interferon-a and somatostatin analogues can be employed.
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PMID:[Glucagonoma--somatostatinoma]. 1044 13


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