OVERVIEW

What are endocrine pancreatic diseases?

The pancreas has a "dual role," performing both exocrine and endocrine functions.
The exocrine "function" of the pancreas mainly involves secreting digestive enzymes, which break down ingested food into nutrients that can be absorbed by the intestines.
The endocrine "function" of the pancreas primarily involves secreting hormones, such as insulin, glucagon, somatostatin, and pancreatic polypeptide, to regulate the absorption of digested nutrients, as well as the storage and metabolism of these absorbed nutrients in the body.
If problems arise with the endocrine hormones of the pancreas (e.g., decreased or increased secretion) or if these hormones fail to function properly (e.g., abnormal hormone responses), it can lead to an imbalance in the body's nutritional homeostasis, causing a series of issues such as hypoglycemia, diabetes, and other metabolic abnormalities. These conditions are collectively referred to as endocrine pancreatic diseases.

What diseases are included in endocrine pancreatic diseases?

They include diabetes and pancreatic endocrine tumors, such as insulinomas, glucagonomas, somatostatinomas, VIPomas, and gastrinomas.

SYMPTOMS

What are the manifestations of endocrine pancreatic diseases?

• Symptoms of hyperglycemia known as the "three excesses and one deficiency": dry mouth, excessive thirst, frequent urination, increased appetite, and weight loss. However, it should be noted that most diabetic patients may not experience any discomfort in the early stages. Diabetes is often diagnosed incidentally through elevated blood sugar levels detected during physical examinations or pre-surgical tests.

• Whipple's triad for hypoglycemia: ① Symptoms such as palpitations, trembling hands, cold sweats, hunger, or even drowsiness and coma during a hypoglycemic episode; ② Blood glucose levels below 2.8 mmol/L; ③ Significant symptom relief after eating.

• Symptoms of peptic ulcers: such as abdominal pain and melena. Peptic ulcers caused by endocrine pancreatic diseases are characterized by being refractory, multiple, and recurrent.

• Dermatitis or skin rashes: often of unknown origin and recently developed.

• Diarrhea: primarily watery diarrhea.

• Skin flushing: presents in episodic attacks.

• Electrolyte and acid-base imbalances: such as persistent, refractory hypercalcemia, hypokalemia, or alkalosis.

• Gallstones.

CAUSES

What are the causes of endocrine pancreatic diseases?

In general, the causes of endocrine pancreatic diseases are not yet clear. Type 2 diabetes may be related to genetic and acquired environmental factors. The causes of pancreatic endocrine tumors are mostly unknown. Current research has found that many tumors are associated with somatic gene mutations, while others are caused by germline gene mutations (which can be inherited within families).

Are endocrine pancreatic diseases contagious?

Endocrine pancreatic diseases are not contagious.

DIAGNOSIS

How are endocrine pancreatic diseases diagnosed?

The most common endocrine pancreatic disease is diabetes mellitus, which is caused by insufficient insulin secretion or reduced insulin effectiveness (often referred to as "decreased insulin sensitivity" or "insulin resistance"), leading to elevated blood sugar levels. Most diabetic patients may not experience any noticeable symptoms in the early stages and are only diagnosed when elevated blood sugar is detected during routine check-ups or pre-surgical tests. A small number of diabetic patients may exhibit early symptoms such as dry mouth, excessive thirst, frequent urination, increased appetite, and weight loss—commonly known as the "three excesses and one deficiency" symptoms.
In addition to diabetes, endocrine pancreatic diseases also include pancreatic endocrine tumors, which are often insidious in onset and not easily detectable, leading to delayed or missed diagnoses. The possibility of pancreatic endocrine diseases should be considered when any of the following conditions occur:

• Fasting hypoglycemia;
• Multiple, recurrent, or refractory peptic ulcers;
• Unexplained skin rashes;
• Diarrhea without other identifiable causes;
• Malabsorption without other explainable reasons;
• Recent onset of diabetes in elderly individuals with no family history;
• Unexplained hypercalcemia, hypokalemia, alkalosis, or episodic skin flushing;
• One or more of the above conditions accompanied by gallstones.

What tests are needed to diagnose endocrine pancreatic diseases?

Endocrine pancreatic diseases primarily cause abnormal hormone secretion, so testing mainly focuses on measuring relevant hormone levels—this is referred to as "qualitative diagnosis." Additionally, for tumor-related endocrine pancreatic diseases, imaging tests are required to locate the tumor, known as "localization diagnosis." Specific tests include:

• Insulin release test: Primarily used to assess pancreatic β-cell function and aid in diabetes classification.

• Insulin release index: Mainly used to analyze the cause of fasting hypoglycemia and diagnose insulinoma.

• Gastrin measurement and stimulation test: Used for the diagnosis of gastrinoma.

• Glucagon measurement: Used for the diagnosis of glucagonoma.

• Vasoactive intestinal peptide (VIP) measurement: Used for the diagnosis of VIPoma.

• Somatostatin measurement: Used for the diagnosis of somatostatinoma.

• Ultrasound, endoscopic ultrasound, CT, MRI, somatostatin receptor scintigraphy, or positron emission tomography (PET): Used to locate lesions and determine the presence of metastases.

• Selective angiography: Used for the localization diagnosis of insulinoma, gastrinoma, and glucagonoma.

TREATMENT

Which department should I visit for endocrine pancreatic diseases?

Endocrine pancreatic diseases often require collaborative treatment from multiple departments. It is first recommended to visit the endocrinology department for diagnosis. If surgical treatment is needed, patients will be referred to the general surgery department.

Can endocrine pancreatic diseases heal on their own?

Endocrine pancreatic diseases do not resolve on their own. Once diagnosed, active treatment should be pursued.

How are endocrine pancreatic diseases treated?

Treatment includes medication and surgery.
Medication is primarily used to regulate hormone secretion and alleviate symptoms.

• For insufficient hormone secretion: For high blood sugar caused by insufficient insulin secretion or insulin resistance, blood sugar-regulating drugs (oral hypoglycemic agents) or insulin may be used alongside diet and exercise adjustments, depending on the specific condition.

• For excessive hormone secretion: For excessive gastric acid secretion caused by gastrinomas, H2 receptor blockers or proton pump inhibitors (e.g., esomeprazole) can be used to suppress acid production. For excessive insulin secretion due to insulinomas, diazoxide may be administered. Diarrhea caused by VIPomas, gastrinomas, or somatostatinomas can be relieved with chloride secretion inhibitors. Somatostatin analogs, such as octreotide or lanreotide, are effective for most pancreatic endocrine tumors (except somatostatinomas). Chemotherapy may also be used for some tumors, such as streptozocin for malignant insulinomas or dacarbazine for glucagonomas and VIPomas.

Surgery is primarily used to control symptoms caused by excessive hormone secretion and to manage tumor growth and spread.

• Once diagnosed and localized, the tumor should be surgically removed as early as possible. Minimally invasive laparoscopic resection is suitable for small, non-metastatic lesions, offering faster recovery.

DIET & LIFESTYLE

What should patients with endocrine pancreatic diseases pay attention to in daily life?

• For diabetic patients, maintaining a healthy lifestyle is crucial for disease control, including a balanced diet, moderate exercise, regular routines, quitting smoking, and limiting alcohol intake.

• For insulinoma patients, eating small frequent meals and avoiding overly soft or mushy foods that are absorbed too quickly can help prevent hypoglycemia.

PREVENTION

How to Prevent Endocrine Pancreatic Diseases?

The causes of most endocrine pancreatic diseases are unclear, and there are no effective preventive measures.
However, type 2 diabetes can be prevented, especially for individuals with a family history of diabetes, overweight, hypertension, or hyperlipidemia. Adopting a balanced diet, regular exercise, a disciplined lifestyle, quitting smoking, limiting alcohol, and maintaining a healthy weight can effectively prevent type 2 diabetes. Click directly to view "Type 2 Diabetes" for further details.