Neuroendocrine tumors.
- Neuroendocrine neoplasms are a heterogeneous group of tumors originating from neuroendocrine cells, which share characteristics with both nerve cells and hormone-producing cells.
- Most of these neoplasms occur in the gastrointestinal system (e.g., carcinoid, gastrinoma), pancreas (e.g., insulinoma, glucagonoma), and lungs (e.g., small cell carcinoma). They can also be found in the thyroid (e.g., medullary carcinoma) and adrenal glands (e.g., pheochromocytoma).
- Despite differences in embryologic origin, anatomic site, and secretory products, neuroendocrine cells such as pancreatic β cells and enterochromaffin cells share a common biological function via amine precursor uptake decarboxylase (APUD). Secretory products can include chromogranin A, neuron-specific enolase (NSE), synaptophysin, serotonin, histamine, and calcitonin.
▪ Treatment: surgical resection, somatostatin analogs.
Insulinoma.
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The most common islet cell tumor.
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This is a tumor of pancreatic β cells, which leads to overproduction of insulin and subsequently, hypoglycemia.
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The most common symptoms are due to hypoglycemia and include confusion, disorientation, and headaches.
The Whipple triad may be observed, which consists of:
- Low blood glucose.
- Symptoms of hypoglycemia like lethargy, syncope, and diplopia.
- Resolution of these symptoms after the normalization of glucose levels.
- Symptomatic patients exhibit lower blood glucose and higher C-peptide levels compared to those using exogenous insulin.