Endocrine and Pancreatic Disorders

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Table of Contents

Abstract3

Introduction4

Endocrine Disorders that Cause Diabetes4

Pancreatic Diseases and Diabetes6

Discussion7

Conclusion7

Abstract

Endocrine disorders and pancreatic diseases have a role to play in diabetes. Endocrine disorders cause diabetes by inhibiting insulin secretion and action; thus, reducing insulin levels that are necessary in checking hyperglycemia. Conversely, pancreatic disorders cause pancreatic insufficiency that affects the release of insulin. The diseases affect the pancreas by damaging the endocrine and exocrine components. However, they account for a small percentage of diabetic cases as compared to endocrine disorders.

Endocrine and Pancreatic Disorders

Introduction

Endocrine maladies cause diabetes when the hormones that regulate the levels of insulin are in excess. Thus, they inhibit the secretion of insulin, which also affects its action. The disorders are referred to as endocrinopathies and include Cushing syndrome, acromegaly, pheochromocytoma, glucagonoma, somatostatinoma, thyrotoxicosis, polycystic ovarian syndrome, primary hyperparathyroidism and primary aldosteronism. Pancreatic disorders include acute and chronic pancreatitis, hereditary hemochromatosis, pancreatic carcinoma, cystic fibrosis, and calcific pancreatitis. The essay discusses the disorders and their contribution to diabetes.

Endocrine Disorders that Cause Diabetes

Acromegaly occurs when there is excess secretion of growth hormone leading to overgrowth of soft and bony tissues, and pathological metabolic and cardiovascular systems. A majority of the cases is caused by pituitary adenoma while few cases occur due to excess GH -releasing hormone secretion by a carcinoid or hypothalamic gangliocytoma tumor in the pancreas or lung. Mutations in the tumor suppressor gene also cause acromegaly, but rarely. Diabetes in acromegaly occurs when the hyperglycemic effects of GH are in excess. This type of diabetes is common among patients with higher levels of GH. Maintenance of acromegaly diabetes includes proper diet or oral hypoglycemic agents.

Cushing syndrome occurs when the levels of glucocorticoid are in excess leading to cardiovascular and metabolic pathology in patients. Exogenous administration of synthetic glucocorticoids used to treat rheumatoid arthritis or acute airways disease is the main cause of Cushing syndrome. High levels of cortisol, the major glucocorticoids in humans, are responsible for the external characteristics of the disease and cardiovascular morbidity and mortality. Cushing syndrome causes hyperglycemia by increasing hepatic glucose production and reducing insulin stimulated glucose uptake and utilization by peripheral tissues; thus, inducing insulin resistance. Treatment for the syndrome includes administration of replacement doses of hydrocortisone and continuous antidiabetes medication to prevent hyperglycemia.

Pheochromocytoma occurs due to excessive production of catecholamine-secreting tumors called pheochromocytomas. Excess secretion of catecholamine is responsible for the clinical manifestations of the disorder such as sweating, tachycardia, hypertension and headaches. Majority of people with pheochromocytoma are diagnosed with diabetes since catecholamines reduce insulin secretion and sensitivity leading to hyperglycemia. Treatment involves surgical removal of the tumors to reduce the secretion of catecholamine; thus, correcting the metabolic abnormalities.

Other endocrinopathies that cause glucose intolerance include somatostatinoma and glucagonoma, which are δ-cells and α-cells pancreatic islet tumors respectively, secreting hormones that inhibit insulin secretion and action. Glucagonoma leads to diabetes accompanied by a chronic skin rash and weight loss. Treatment of both disorders includes hepatic artery embolization or chemotherapy. Thyrotoxicosis occurs due to increased thyroid hormone in the circulatory system. In turn, there is impaired secretion of insulin and insulin resistance leading to hyperglycemia. The condition is manageable through treatment of hyperthyroidism to reduce the levels of thyroid hormone. Primary hyperparathyroidism and hyperaldosteronism involves over secretion of parathyroid hormone and aldosterone respectively, leading to glucose intolerance. Polycystic ovarian syndrome occurs in reproductive women characterized by multiple ovarian cysts. The syndrome increases insulin resistance and glucose intolerance leading to diabetes in about 50% of women having the syndrome.

Pancreatic Disorders and Diabetes

Acute pancreatitis occurs due to gallstones and alcoholism where patients present symptoms such as epigastric pain, nausea, vomiting, fever and jaundice. Patients with acute pancreatitis have transient hyperglycemia due to increased glucagon levels. The hyperglycemia resolves within a few days sans the need for insulin therapy. Chronic pancreatitis occurs when the exocrine pancreatic tissue is irreversibly and progressively damaged. Consequently, there is pancreatic insufficiency and glucose intolerance that require insulin. Alcoholism is the major cause although some cases are hereditary. Chronic calcific pancreatitis occurs when the acinar and ductal lumina have proteinaceous plugs that calcify forming calcium carbonate stones. The disorder mainly manifests in the form of severe abdominal pain.

Hereditary hemochromatosis is an autosomal recessive genetic disorder common among the Caucasians. Clinical manifestations include diabetes, hyperpigmentation, and hepatic cirrhosis. Cirrhosis and iron overload often lead to the prevalence of diabetes in most patients who require insulin for the management of the disease. Treatment includes repeated venesection, which prolongs survival and prevents cirrhosis and diabetes. Other pancreatic disorders include pancreatic carcinoma and cystic fibrosis, which are associated with diabetes due to pancreatic insufficiency. Pancreatic surgery coupled with proper meals low in fat and high in protein and carbohydrate are essential tools in the management of diabetes since they help in stabilizing blood glucose.

Discussion

Endocrine and pancreatic disorders lead to diabetes because they destabilize glucose levels in the blood. Endocrine disorders involve excess production of counter-regulatory hormones, which inhibit the secretion and action of insulin. Thus, there is insulin resistance and glucose intolerance leading to hyperglycemia or diabetes. By contrast, pancreatic disorders rarely lead to diabetes, as compared to endocrine disorders. Pancreatic disorders often lead to pancreatic insufficiency, which reduces the release of insulin by the pancreas. Thus, diabetes occurs due to low insulin levels and unstable blood glucose levels.

Conclusion

The aforementioned disorders have a role to play as far as diabetes is concerned. They cause unstable glucose levels in the blood leading to diabetes. However, management and treatment of the disorders and proper diet help in stabilizing blood glucose; thus, managing and controlling diabetes. Administration of hypoglycemic agents to check hyperglycemia and surgery to remove tumors and deformations are significant measures in managing the disease.