c-peptide and Pancreatic-Pseudocyst

Therapeutic pancreatic duct occlusion (PDO) is applied to preserve endocrine pancreatic function by atrophizing and thus eliminating chronically inflamed exocrine pancreatic parenchyma. So far, efficient and lasting elimination of exocrine parenchyma is brought about only by intraoperative PDO upon partial duodenopancreatectomy. While partial duodenopancreatectomy itself reduces endocrine pancreatic function by about 40%, intraoperative PDO does not further impair endocrine function. Endocrine function is not affected at all by endoscopic PDO, which has to be improved, however, concerning its eliminatory effect on exocrine pancreatic parenchyma.

Topics: Blood Glucose; C-Peptide; Chronic Disease; Diatrizoate; Drug Combinations; Endoscopy; Fatty Acids; Follow-Up Studies; Humans; Insulin; Isoamylase; Lipase; Pancreatectomy; Pancreatic Ducts; Pancreatic Function Tests; Pancreatic Pseudocyst; Pancreatitis; Postoperative Complications; Propylene Glycols; Proteins; Trypsin; Zein

After an acute episode of pancreatitis, a 63-year-old man was found to have a pancreatic glucagonoma. The tumor was resected without evidence of metastases. Three years later he had symptoms of uncontrolled diabetes, no skin lesions, and diarrhea and was found to have a pancreatic pseudocyst and multiple hepatic metastases. Glucagon concentrations were raised but were suppressible by glucose and somatostatin and responded to arginine stimulation. He was treated for 6 months with octreotide (Sandostatin), which reduced his symptoms; the pseudocyst resolved, but liver metastases continued to grow. Although spontaneous resolution of the pseudocyst is possible, this case appears to illustrate differences in sensitivity of endocrine and exocrine tissues to suppression by Sandostatin.

Topics: Adenoma, Islet Cell; Arginine; Blood Glucose; C-Peptide; Eosinophilia; Follow-Up Studies; Glucagon; Glucagonoma; Humans; Male; Middle Aged; Octreotide; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst