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$Unique_ID{BRK04080}
$Pretitle{}
$Title{Pancreatic Islet-Cell Tumor}
$Subject{Pancreatic Islet-Cell Tumor Endocrine Tumor Encephalopathy
Hypoglycemic Multiple Endocrine Adenomatosis Zollinger-Ellison Syndrome
Hypoglycemia}
$Volume{}
$Log{}
Copyright (C) 1990 National Organization for Rare Disorders, Inc.
716:
Pancreatic Islet-Cell Tumor
** IMPORTANT **
It is possible that the main title of the article (Pancreatic Islet-Cell
Tumor) is not the name you expected. Please check the SYNONYM listing to
find the alternate names and disorder subdivisions covered by this article.
Synonyms
Endocrine Tumor
Encephalopathy, Hypoglycemic
Multiple Endocrine Adenomatosis
Information on the following diseases can be found in the Related
Disorders section of this report:
Zollinger-Ellison Syndrome
Hypoglycemia
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Pancreatic-islet cell tumors appear in one of two forms. They may be
non functioning or functioning tumors. Nonfunctioning tumors may cause
obstruction in the shortest part of the small intestine (duodenum) or in the
biliary tract which connects the liver to the duodenum and includes the gall
bladder. These nonfunctioning tumors may erode and bleed into the stomach
and/or the intestines, or they may cause an abdominal mass.
Functioning tumors secrete excessive amounts of hormones which may lead
to various syndromes including low blood sugar (hypoglycemia), multiple
bleeding ulcers (Zollinger-Ellison Syndrome), pancreatic cholera (Verner-
Morrison Syndrome), carcinoid syndrome or diabetes.
Islet cells are small, isolated masses of cells which make up the Islet
of Langerhans in the pancreas. When functioning normally, they secrete the
protein hormones insulin and glucagon. Tumors composed of irregular islet
cells may occur alone or in a group of many tumors. Approximately 90% of
islet-cell tumors are noncancerous (benign). They usually range in size from
0.5 to 2 cm in diameter.
Symptoms
Symptoms of pancreatic islet-cell tumor vary with the type of hormone-
producing tumor that occurs. Generally, symptoms include periodic attacks of
pain in the abdomen which increase in severity and frequency. Insulin-
secreting tumors may result in abnormally low blood sugar (hypoglycemia), and
may produce such symptoms as headache, visual disturbances, confusion,
weakness, sweating, uncontrollable tremors or quivering, loss of muscular
coordination (ataxia), personality changes, palpitations, convulsions or
coma. Symptoms of severe hypoglycemia may be confused with those of many
neurologic or psychiatric disorders.
Pancreatic islet-cell tumors which produce the hormone gastrin commonly
result in multiple ulcers. Approximately 50% of these tumors are benign and
their growth and spread are slow. Symptoms of ulcers may include
gastrointestinal bleeding, stomach pain and diarrhea.
Zollinger-Ellison Syndrome is characterized by multiple ulcers which may
be caused by gastrin secreting islet-cell tumors of the pancreas. These
ulcers commonly bleed, cause stomach pain and diarrhea. (For more
information on this disorder, choose "Zollinger-Ellison" as your search term
in the Rare Disease Database).
Certain pancreatic islet-cell tumors which secret the hormone vasoactive
intestinal polypeptide (VIP) are responsible for such symptoms as severe
watery diarrhea, dehydration, intermittent vomiting, weight loss, weakness,
decreased potassium in the blood (hypokalemia), excess calcium in the blood
(hypercalcemia), reduced or absent gastric secretion and degenerative changes
in the spine. This disorder is called Verner-Morrison Syndrome or Pancreatic
Cholera.
Causes
The exact cause of pancreatic islet-cell tumors is not known. However
scientists believe certain forms of this disorder may be inherited.
Human traits, including the classic genetic diseases, are the product of
the interaction of two genes, one received from the father and one from the
mother. Verner-Morrison syndrome and a particular form of Zollinger-Ellison
syndrome are inherited as autosomal dominant traits.
In dominant disorders a single copy of the disease gene (received from
either the mother or father) will be expressed "dominating" the other normal
gene and resulting in appearance of the disease. The risk of transmitting
the disorder from affected parent to offspring is fifty percent for each
pregnancy regardless of the sex of the resulting child.
Affected Population
Pancreatic islet-cell tumors occur most often in males between the ages of 30
and 60.
Related Disorders
Symptoms of the following disorder can be similar to those of Pancreatic
Isleta-Cell Tumors. Comparisons may be useful for a differential diagnosis:
Hypoglycemia is characterized by abnormally low blood sugar, and may be
caused by excess insulin in the body. Symptoms of hypoglycemia may include
faintness, weakness, jitteriness, profuse perspiration, excessive hunger and
nervousness. Islet-cell tumors of the pancreas may be one source of the
excess insulin, although hypoglycemia often occurs for unknown reasons. (For
more information on this disorder, choose "Hypoglycemia" as your search term
in the Rare Disease Database).
Therapies: Standard
Small benign tumors at or near the surface of the pancreas can usually be
surgically removed. If the tumor is large or deep into the body or tail of
the pancreas, a portion of the pancreas may be removed. Total removal of the
pancreas (pancreatectomy) is reserved only for large malignant tumors of the
pancreas. Surgical cure rates are very high for small benign tumors. The
drugs Diazoxide and Streptozocin (for insulinoma) are frequently administered
to control symptoms or reduce the size of the tumor.
Gastrin secreting pancreatic islet-cell tumors (Zollinger-Ellison
Syndrome) may be treated with the drug Cimetidine which greatly reduces
gastric acid output and promotes healing and alleviates symptoms. Surgical
removal of the tumor is possible in approximately 20% of all patients.
Streptozocin is also used to reduce diarrhea and tumor mass. The drug
Sandostatin has been found to be effective in controlling diarrhea and
suppressing secretion of the hormones gastrin, insulin, glucagon and VIP by
islet-cell tumors.
Pancreatic cholera (Verner-Morrison Syndrome) must be treated by
replacing fluids and electrolytes lost in numerous watery stools. The tumor
may be surgically removed in approximately 50% of the cases. Streptozocin
may also be administered to reduce diarrhea and tumor mass. Some individuals
may respond to a corticosteroid drug such as Prednisone. Sandostatin may be
administered for severe diarrhea and to reduce elevated VIP levels produced
by islet-cell tumors.
Therapies: Investigational
This disease entry is based upon medical information available through July
1990. Since NORD's resources are limited, it is not possible to keep every
entry in the Rare Disease Database completely current and accurate. Please
check with the agencies listed in the Resources section for the most current
information about this disorder.
Resources
For more information on Pancreatic Islet-Cell Tumors, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
National Digestive Diseases Information Clearinghouse
Box NDDIC
Bethesda, MD 20892
(301) 468-6344
American Cancer Society
1599 Clifton Rd., NE
Atlanta, GA 30329
(404) 320-3333
International Tremor Foundation
360 W. Superior St.
Chicago, IL 60610
(312) 664-2344
For genetic information and genetic counseling referrals:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
References
INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and
Co., 1987. Pp. 269-271.
THE MERCK MANUAL, Volume 1, 14th Ed.: Robert Berkow, M.D., ed.-in-chief;
Merck Sharp & Dohme Laboratories, 1982. Pp. 495-499.
ISLET CELL CARCINOMAS OF THE PANCREAS: A TWENTY YEAR EXPERIENCE. G.B.
Thompson et al; SURGERY, (Dec 1988; 104(6):1011-1017).
NONFUNCTIONING ISLET CELL CARCINOMA OF THE PANCREAS. COMPLETE RESPONSE TO
CONTINUOUS 5-FLUOROURACIL INFUSION. R. Hansen et al; CANCER, (Jul 1 1988;
62(1):15-17).