胰腺疾病-2013.ppt

Non-functional endocrine tumor No endocrine disturbance clinically. Often large ( more than 10 cm). Hemorrhage and necrosis are often found. Mutiple hormone secretion as detected by immunohistochemistry. 无功能胰腺内分泌肿瘤 临床上无内分泌失衡的表现 常很大 常见出血和囊性变 免疫组化常可检测到多种内分泌激素 Multiple endocrine neoplasm (MEN) Type 1 Type 2A Type2B Pituitary 30% Parathyroid 95% About 30% same Pancreas 40% Z-E syndrome Thyroid C +++ +++ Adrenal Medulla 50% +++ Ganglioneuromas or marfanoid habitus +++ Diabetes Mellitus A group disorders Defective or dificient insulin secretory response. Glucose underutilization Hyperglycemia Tendency to develop nephropathy, vascular disease, eye disease, etc. 糖尿病 一组全身性疾病 胰岛素分泌反应的缺陷或不足 糖利用不足 高血糖 易发肾病、血管疾病、眼疾病等 Classification of DM Primary DM: Type I -- IDDM: Insulin-dependent DM, Juvenile-onset DM, Kerosis-prone DM).10-20%. Type II -- NIDDM non-insulin-dependent DM, adult onset DM. Secondary DM 糖尿病的分类 原发性糖尿病： I型：胰岛素依赖型（IDDM），幼年发作型，易发酮症。 占10-20% II型：非胰岛素依赖型（NIDDM），承认发作型。占80-90%。 继发性糖尿病 Secondary DM Inflammation ( e.g. pancreatitis) Surgery (pancreatectomy) Tumors (pheochromocytoma, pituitary tumors) Drugs (corticosteroids) iron overload (hemochromatosis) genetic disorders (e.g. Lipodystrophy) 继发性糖尿病 炎症 （如胰腺炎） 手术 （胰腺切除） 肿瘤 （嗜铬细胞瘤、垂体肿瘤、肾上腺皮质腺瘤等） 药物 如皮质激素 血色病 遗传性疾病 如脂质营养不良 Functions of insulin Transmembrane transport of glucose and aa. Glycogen formation. Conversion of glucose to triglycerides. Nucleic acid synthesis. Protein synthesis. 胰岛素的功能 葡萄糖和氨基酸的跨膜转运 糖原合成 促进葡萄糖转换成脂肪 核酸合成 蛋白质合成 Glucagonoma Glucagonoma syndrome: necrotic migratory erythema, mild glucose intolerance, normacytic anaemia, weight loss, depression, a tendency to develop deep vein thrombosis. More than 60% with metastasis. Pancreas. 胰高血糖素瘤 高血糖素瘤综合症：游走性坏死性红斑、轻度糖耐量异常、贫血、消瘦、抑郁、易发深静脉血栓 60%以上发现时已有转移 发生在胰腺 glucagonoma glucagonoma Somatostatinoma Inhibitory syndrome clinically More than 50% are with metastasis. Pancreas, stomach and duodeum. 生长抑素瘤 抑制综合症 至少50%以上发现时已有转移 发生在胰腺、胃和十二指肠 somato