Diseases of the pancreas

The pancreas is located in the middle of the abdomen, next to the first part of the small intestine (duodenum), the major blood vessels to the liver and intestines, and the spleen. It has cells that make digestive enzymes and juices (exocrine), and cells that make hormones (endocrine).

Disease types

Neuroendocrine tumors (NET) of the pancreas/duodenum

These are rare tumors. They are most often sporadic (not inherited), but some may be part of inherited syndromes such as MEN or Von Hippel-Lindau.

Nonfunctioning NETs of the pancreas

These tumors do not produce hormones that cause symptoms. Therefore they are usually discovered late. If the disease has not spread outside of the pancreas, the best treatment is usually surgery.

Gastrinoma

These tumors produce gastrin, which can lead to ulcers and diarrhea, known as Zollinger-Ellison syndrome. The tumors are found in the “gastrinoma triangle”, which encompasses the duodenum and the head of the pancreas. They sometimes spread to lymph nodes, liver and other organs. Gastrinomas may be part of the MEN1 syndrome.

Insulinoma

These tumors produce insulin, which leads to profound hypoglycemia and symptoms of mental status changes, and loss of consciousness. The symptoms disappear with eating sugary foods. Most (90%) are benign. They are often difficult to diagnose and localize. Insulinomas may be part of the MEN1 syndrome.

Other hormone-producing pancreatic NETs

Additional very rare tumors include somatostatinomas, VIPomas, and glucagonomas.

Endocrine pancreas surgery

Many pancreatic neuroendocrine tumors may be removed with enucleation, which essentially shells out the tumor from the pancreas gland. However, removal of part of the gland is sometimes required. A pancreaticoduodenectomy or Whipple procedure removes the head of the pancreas, and a distal pancreatectomy removes the body and tail of the pancreas.

Endocrine pancreas surgery pre- and post-operative care

Preoperative preparation for pancreas surgery

Patients with functional neuroendocrine tumors of the pancreas will need to have the effects of hormone excess controlled prior to surgery. For example, patients with gastrinomas will need to be on proton pump inhibitors perioperatively. Patients with insulinomas will need to be admitted overnight to the hospital for IV glucose infusions and frequent glucose determinations while they are NPO (nothing by mouth) prior to surgery.

Last reviewed: 
May 2018

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