Clinical Implications Of Exocrine And Endocrine Interactions

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Exocrine-endocrine pancreatic functional interrelationships play a significant role in the development of endocrine and exocrine disorders of the pancreas. Disorders of the exocrine pancreas, such as chronic and acute pancreatitis and pancreatic adenocarcinoma, can induce endocrine pancreatic disorders such as diabetes mellitus and islet cancer.35 In turn, diabetes and glucose intolerance are often associated with exocrine pancreatic dysfunction, and may participate in pancreatic carcinogenesis. New epidemiological studies confirmed that glucose intolerance is a risk factor for pancreatic cancer, such that association cannot be accounted for by an adverse impact of early pancreatic cancer on p-cell function42 and that insulin may also act as a promoter for pancreatic carcinogenesis. Recently, the nutritional factor link to pancreatic carcinogenesis became a main focus of interest.43 These include dietary roles and interaction between various risk factors, including hyperinsulinemia, diabetes mellitus, chronic pancreatitis, obesity and energy balance, hereditary pancreatitis, and genetic polymorphisms that affect carcinogen metabolism of epigenetic mechanisms.43,44 In addition, biomarker investigation has become an area of great promise. Genomic, proteomic, and metabolic profiling are now utilized in not only pancreatic cancer but also inflammatory and genetic diseases of the pancreas (see also Chapter 19, Chapter 20, and Chapters 23-25). In fact, pancreatic cancer and inflammatory diseases are now considered to be preventable.45,46

Currently, exocrine pancreatic insufficiencies are managed by using high-dose pancreatic minimicrospheres to achieve acceptable result by improving their nutrient absorptive function.47 However, it has recently been demonstrated that chronic pancreatitis patients receiving this enzyme replacement show exacerbated pancreatic endocrine dysfunction, 48 because of their improved carbohydrate malabsorption, which led to a brittle nature of the blood glucose control in the malnourished insulin-dependent patients. Therefore, understanding the exocrine-endocrine functional interrelationships that underlie the development of numerous exocrine and endocrine pancreatic disorders gives way to important implications for clinical diagnosis and treatment of these diseases.

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