Interactions between the endocrine and exocrine pancreas and their clinical relevance

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

In consequence of the close anatomical and functional links between the exocrine and endocrine pancreas, any disease affecting one of these parts will inevitably affect the other. Pancreatic conditions which might cause diabetes mellitus include acute and chronic pancreatitis, pancreatic surgery, cystic fibrosis and pancreatic cancer. The development of diabetes greatly influences the prognosis and quality of life of patients with exocrine pancreatic diseases. It may cause life-threatening complications, such as hypoglycemia, due to the lack of glucagon and the impaired absorption of nutrients, or the micro- and macrovascular complications may impair the organ functions. Diabetes mellitus is an independent risk factor of mortality in those with exocrine pancreatic diseases. The treatment of pancreatic diabetes, a distinct metabolic and clinical form of diabetes, requires special knowledge. Diet and pancreatic enzyme replacement therapy may be sufficient in the early stages. Oral antidiabetic drugs are not recommended. If the diet proves inadequate to reach the glycemic goals, insulin treatment with multiple injections is required. Impairments of the exocrine pancreatic function and morphology in diabetic patients are frequent and well known. Atrophy of the exocrine tissue may be caused by the lack of trophic insulin, whereas pancreatic fibrosis can result from activation of stellate cells by hyperglycemia, or from microangiopathy and neuropathy. The regulation of the exocrine pancreatic function is also damaged because of the impaired effect of islet hormones. In the event of a proven impairment of the pancreatic exocrine function in diabetes mellitus, pancreatic enzyme replacement therapy is indicated. This may improve the nutritional condition of the patient and decrease the metabolic instability.

Original languageEnglish
Pages (from-to)351-359
Number of pages9
JournalPancreatology
Volume9
Issue number4
DOIs
Publication statusPublished - Jun 2009

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Exocrine Pancreas
Islets of Langerhans
Enzyme Replacement Therapy
Pancreatic Diseases
Diabetes Mellitus
Insulin
Diet
Chronic Pancreatitis
Glucagon
Pancreatic Neoplasms
Hypoglycemia
Hypoglycemic Agents
Cystic Fibrosis
Hyperglycemia
Atrophy
Fibrosis
Quality of Life
Hormones
Food
Injections

Keywords

  • Chronic pancreatitis
  • Diet
  • Enzyme replacement therapy
  • Exocrine pancreatic function
  • Glucagon
  • Insulin
  • Insulin therapy
  • Pancreatic diabetes

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Hepatology

Cite this

Interactions between the endocrine and exocrine pancreas and their clinical relevance. / Czakó, L.; Hegyi, P.; Rakonczay, Z.; Wittmann, T.; Otsuki, Makoto.

In: Pancreatology, Vol. 9, No. 4, 06.2009, p. 351-359.

Research output: Contribution to journalArticle

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