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Rosalynn's ABSITE > Endocrine pancreas syndromes > Flashcards

Endocrine pancreas syndromes Flashcards

(51 cards)

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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?

Study These Flashcards
A

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

22
Q

what is the first imaging for PNETs?

Study These Flashcards
A

CT triple phase or MRI

23
Q

what is the treatment for gastrinomas?

Study These Flashcards
A

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

24
Q

what is the treatment for metastatic gastrinomas?

Study These Flashcards
A

50% of pts. focus on symptom control

25
what are the symptoms of glucagonoma?
4D's: diabetes, dermatitis (necrolytic migratory erythema), depression, DVT, weight loss
26
mostly malignant PNET
glucagonoma, 90% (distal pancreas)
27
treatment for glucagonoma
formal resection w/regional lymph node dissection for all (high malignancy rate) + cholecystectomy
28
what can you give to help the rash with glucagonomas?
zinc, amino acids, fatty acids
29
what are the symptoms with VIPoma
watery diarrhea, hypokalemia, achlorhydria (WDHA)
30
are VIPomas mostly benign or malignant?
malignant
31
where are VIPomas found usually
distal pancreas
32
what is the treatment for VIPomas
formal resection with lymph node dissection + cholecystectomy
33
What are the symptoms of somatostatinoma?
diabetes, gallstones, steatorrhea
34
how do you dx somatostatinoma?
fasting somatostatin level
35
are somatostatinomas mostly benign or malignant?
malignant
36
what is the treatment for somatostatinomas?
formal resection with lymph node dissection + cholecystectomy
37
glucagon is made where
alpha cells
38
insulin is made where
beta cells (at center of islets)
39
somatostatin is made where
D cells
40
pancreatic polypeptide is made where
PP or F cells
41
VIP and serotonin are made where
islet cells
42
what does enterokinase do
released by duodenum and activates trypsinogen to trypsin
43
what does trypsin do
activates other pancreatic enzymes including trypsinogen
44
what does secretin do
increase HCO3 mostly
45
what does CCK do?
increase pancreatic enzymes
46
what does acetylcholine do
increase HCO3 and enzymes
47
what does somatostatin and glucagon do
decrease exocrine function
48
where does CCK and secretin come from
most released by cells in duodenum
49
what is the affect of CCK and glucagon on the sphincter of Oddi?
relaxes the sphincter
50
what are the exocrine enzymes of the pancreas?
amylase, lipase, trypsinogen, chymotrypsinogen, carboxypeptidase, HCO3
51
what is the only pancreatic enzyme that is released in its active form?
amylase - hydrolyzes alpha 1-4 linkages of glucose chains

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