The primary causes of uncontrolled diabetes are poor life-style, infection, ischemic heart disease and inappropriate usage of oral anti-diabetic agents and insulin. Supplementary causes are stroke, acute pancreatitis and endocrine diseases. Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant syndrome characterized by primary hyperparathyroidism, pituitary neoplasia, and foregut lineage neuroendocrine tumors, and is associated with increased glucose levels. We present a case of a 69-year-old woman who had polyuria, polydipsia, weight loss and hyperglycemia over 6 months. She had hypertrophy of the face, hand, and foot, and active bleeding and large folds were observed in the stomach and duodenum upon esophagogastroduodenoscopy. She also had high levels of IGF-1 and gastrin and got the failure of growth hormone suppression after an oral glucose load (75 g). These findings suggested a diagnosis of acromegaly and gastrinoma, which was clinically diagnosed along with MEN 1. The patient improved glycemic control and symptoms after being treated with somatostatin analogues and insulin therapy over a 5-month follow-up period. Here, we report a case of MEN 1 in type 2 diabetes mellitus with a poorly controlled blood glucose level. Clinicians should consider endocrine disease in patients with poor glycemic control in diabetes.
Acromegaly ; Aged ; Blood Glucose ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Diagnosis ; Duodenum ; Endocrine System Diseases ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Foot ; Gastrinoma ; Gastrins ; Glucose ; Growth Hormone ; Hand ; Hemorrhage ; Humans ; Hyperglycemia ; Hyperparathyroidism, Primary ; Hypertrophy ; Insulin ; Insulin-Like Growth Factor I ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Myocardial Ischemia ; Neuroendocrine Tumors ; Pancreatitis ; Polydipsia ; Polyuria ; Somatostatin ; Stomach ; Stroke ; Weight Loss

Acute Disease ; Aged ; Amylases ; blood ; Humans ; Lipase ; blood ; Magnetic Resonance Imaging ; Male ; Pancreatitis ; complications ; diagnosis ; diagnostic imaging ; Pancreatitis, Chronic ; complications ; diagnosis ; Panniculitis ; diagnosis ; diagnostic imaging ; etiology ; pathology

Autoimmune pancreatitis (AIP),a special type of chronic pancreatitis,is autoimmune-mediated and can be accompanied by swelling of the pancreas and irregular stenosis of the pancreatic duct. The main pathological features are fibrosis of pancreatic duct with IgG4-positive lymphoplasmacytic infiltration. Different typing methods of AIP can have differerent disease conditions. This paper reviews the history,clinical presentation,diagnostic criteria,and treatment of different AIP types to provide a new basis for the diagnosis and treatment.
Autoimmune Diseases ; diagnosis ; therapy ; Fibrosis ; Humans ; Immunoglobulin G ; blood ; Pancreas ; physiopathology ; Pancreatitis ; diagnosis ; therapy

Drug-induced pancreatitis accounts for 0.1~2.0% of all pancreatitis cases. Generally, the mechanism of drug-induced pancreatitis is an immune reaction, accumulation of toxic material, and/or ischemia. However, how dapsone causes pancreatitis remains unclear. A 61-year-old man presented with a 2-week history of epigastric discomfort. He had taken dapsone for 2 months to treat psoriasis. Laboratory findings showed high blood glucose levels and metabolic acidosis; however, hemoglobin A1c was low. Serum amylase and lipase levels were elevated to 125/4,479 U/L. Abdominal computed tomography was indicative of pancreatitis. There was no causative history of pancreatitis and no other medication history except dapsone. Thus, we reached a diagnosis of diabetic ketoacidosis (DKA) followed by dapsone-induced pancreatitis. The patient fasted and was treated with insulin administration and fluid hydration in accordance with treatment guidelines. After treatment, amylase and lipase decreased and symptoms subsided, but insulin injection was required to control blood glucose levels. Drug-induced pancreatitis is a very rare adverse effect of dapsone. Only four cases of pancreatitis related to dapsone could be found in a PubMed search. Moreover, diabetes caused by dapsone-induced pancreatitis has not been reported previously. Here, we report a case of DKA caused by dapsoneinduced acute pancreatitis.
Acidosis ; Amylases ; Blood Glucose ; Dapsone ; Diabetic Ketoacidosis* ; Diagnosis ; Humans ; Insulin ; Ischemia ; Lipase ; Middle Aged ; Pancreatitis* ; Psoriasis

Aged, 80 and over ; Autoimmune Diseases ; blood ; diagnosis ; Humans ; Immunoglobulin G ; blood ; Lymphatic Diseases ; blood ; diagnosis ; Male ; Mikulicz' Disease ; blood ; diagnosis ; Pancreatitis ; blood ; diagnosis

OBJECTIVETo investigate the clinical feature, diagnostic and therapeutic experience of autoimmune pancreatitis (AIP).

METHODSTwenty-one patients with AIP treated in the First Affiliated Hospital, Harbin Medical University from January 2006 to July 2014 were analyzed retrospectively. There were 15 men and 6 women among the 21 cases and the age ranged from 36 to 64 years. The characters of diagnosis and treatment of AIP were explored through clinical symptoms, imaging features, serologic test results, diagnostic treatment, and histopathologic characteristics.

RESULTSAll the patients showed obstructive jaundice and upper abdominal pain to different extents as major manifestations and the levels of serum IgG4, CA19-9, CEA were elevated in 16 cases (76.2%), 6 cases (28.5%) and 3 cases (14.2%), respectively. CT showed diffuse enlargement of the pancreas in 9 cases, localized pancreatic head enlargement in 3 cases and focally pancreatic mass in 9 cases. AIP was confirmed by extrapancreatic involvement, radiological and serological results plus biopsy in 11 cases (52.4%), interpretation of response to steroid in 3 cases (14.3%) and open laparotomy in 7 cases (33.3%). Surgery included choledochojejunostomy in 3 cases, cholecystojejunostomy in 1 case, pancreaticoduodenectomy in 2 cases and distal pancreatectomy combined with splenectomy in 1 case. The pathologic results displayed massive lymphocytes and plasma cells infiltration in the pancreatic tissues as well as parenchymal fibrosis. Except for 1 patient who had no symptom, the regular steroid therapy was performed (oral prednisone) and all the patients were cured. The follow-up time range was from 3 to 93 months, 4 cases (19.0%) were recurrent followed by the symptoms alleviated after the steroid was applied again.

CONCLUSIONSAIP is rare and characterized by non-specific clinical manifestations so that the early diagnosis is difficult with a high misdiagnosis rate. The clinicians should strengthen the recognition of AIP and the definite diagnosis depends on the combination of clinical manifestations, radiological, serological and histopathological results so as to avoid the unnecessary operation.

Adult ; Autoimmune Diseases ; diagnosis ; therapy ; Biopsy ; CA-19-9 Antigen ; blood ; Carcinoembryonic Antigen ; blood ; Diagnostic Imaging ; Female ; Humans ; Immunoglobulin G ; blood ; Male ; Middle Aged ; Pancreas ; pathology ; Pancreatectomy ; Pancreatitis ; diagnosis ; therapy ; Retrospective Studies ; Steroids ; therapeutic use

A 38-year-old female presented with abdominal pain, radiating to her back. Her medical history included type 2 diabetes, which had been uncontrolled for 8 months. Her initial laboratory tests showed marked hyperglycemia, metabolic acidosis, and elevated serum amylase and lipase levels, although the results were inconclusive in terms of a direct diagnosis of acute pancreatitis (AP). Abdominal computed tomography showed only minimal fluid collection at the pancreas tail. As her serum triglyceride (TG) level was 9,884 mg/dL, we made a working diagnosis of AP due to hypertriglyceridemia, and she was treated with massive hydration with an insulin infusion. Subsequently, she recovered rapidly from the abdominal pain, her serum glucose was controlled, and her serum TG decreased. Hypertriglyceridemia is a well-accepted underlying cause of AP. When extremely high hypertriglyceridemia is detected in patients with type 2 diabetes or metabolic syndrome, complications should be considered and managed.
Abdominal Pain ; Acidosis ; Adult ; Amylases ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Diagnosis ; Female ; Humans ; Hyperglycemia ; Hypertriglyceridemia ; Insulin ; Lipase ; Pancreas ; Pancreatitis* ; Triglycerides

This study was purposed to explore the correlation of regenerating Islet-derived 3-alpha(Reg3α) protein level in plasma with the diagnosis and prognosis of the gastrointestinal acute graft-versus-host disease (GI-aGVHD) after all-HSCT, 103 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were observed in our hospital from December 2011 to December 2012. Peripheral blood samples were routinely collected at 9 d before allo-HSCT, 0 d, 14 d, 28 d after allo-HSCT as well as in aGVHD and at the 1 and 4 weeks after aGVHD therapy. The plasma concentrations of Reg3α were measured by using ELISA kit. The results indicated that among the 103 patients, 17 cases never developed aGVHD symptoms (no-aGVHD), 27 cases presented with non-aGVHD associated diarrhea, 10 cases presented with isolated skin aGVHD, 17 cases developed grades I-II GI-aGVHD, 32 cases with grades III-IV GI-aGVHD. The plasma concentrations of Reg3α in group of patients with GI-aGVHD and group of non-aGVHD diarrhea were 111.5 (54.7-180.2) and 23.9 (14.5-89.5) ng/ml respectively with significant difference (P < 0.001). The plasma concentrations of Reg3α in 17 patients of grades III-IV GI-aGVHD who experienced a complete or partial response and 7 patients who had no response to therapy at 4 weeks were 137.2(51.7-205.4) and 679.4(122.3-896.8) ng/ml respectively with the significant difference (P = 0.028). All of the patients who had no response to therapy died of aGVHD associated multiple organ failure. The area under the ROC curve was 0.902 when plasma concentration of Reg3α was set at 87.73 ng/ml. The sensitivity was 81.48% and the specificity was 82.86% when the critical value was used in diagnosis of grades III-IV GI-aGVHD. The probability of grades III-IV GI-aGVHD had statistical difference above and below 87.73 ng/ml after allo-HSCT (P < 0.001). It is concluded that the increase of plasma Reg3α level after transplantation suggests the incidence of grades III-IV GI-aGVHD. The high level of plasma Reg3α protein in patients with grades III-IV GI-aGVHD after the immunosuppressive treatment for four weeks indicates a poor prognosis. The plasma concentrations of Reg3α can be used as a specific biomarker of GI-aGVHD.
Adolescent ; Adult ; Antigens, Neoplasm ; blood ; Biomarkers, Tumor ; blood ; Female ; Graft vs Host Disease ; diagnosis ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Intestinal Diseases ; diagnosis ; etiology ; Lectins, C-Type ; blood ; Male ; Middle Aged ; Pancreatitis-Associated Proteins ; Plasma ; Prognosis ; Transplantation, Homologous ; Young Adult

PURPOSE: Acute pancreatitis is one of the potentially lethal complications that occurs after cardiac surgery. We tried to identify risk factors for and the prognosis of acute pancreatitis after cardiac valve surgery with cardiopulmonary bypass. MATERIALS AND METHODS: We retrospectively analyzed a database of consecutive patients who underwent cardiac valve surgery with cardiopulmonary bypass between January 2005 and April 2010 at our institution. Patients were classified as having acute pancreatitis based on serum lipase concentration and clinical symptoms (lipase > or =180 U/L or > or =60 U/L with relevant symptoms). RESULTS: Of the 986 patients who underwent cardiac valve surgery with cardiopulmonary bypass, 58 (5.9%) patients developed post-operative pancreatitis. Post-operative hospital stay was significantly longer (29.7+/-45.6 days vs. 12.4+/-10.7 days, p=0.005) and in-hospital mortality rate was higher (15.5% vs. 2.0%, p<0.001) in patients with post-operative pancreatitis than those without. Hypertension, chronic kidney disease, and peri-operative use of norepinephrine were identified as independent risk factors for developing pancreatitis after cardiac valve surgery. CONCLUSION: We found that acute pancreatitis after cardiac valve surgery requires longer hospitalization and increases the in-hospital mortality rate. Clinicians should be aware that patients could develop pancreatitis after cardiac valve surgery, especially in patients with hypertension and chronic kidney disease treated with norepinephrine.
Acute Disease ; Adult ; Aged ; Cardiac Surgical Procedures/adverse effects ; Cardiopulmonary Bypass ; Female ; Heart Valve Diseases/*complications/*surgery ; Heart Valve Prosthesis Implantation/*adverse effects ; Humans ; Lipase/blood ; Male ; Middle Aged ; Multivariate Analysis ; Norepinephrine/therapeutic use ; Pancreatitis/*diagnosis/*etiology ; Postoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors

OBJECTIVETo identify protein markers for the early diagnosis of pancreatic cancer by a comparative proteomic method.

METHODSComparative analysis on the pancreatic peripheral blood protein profiling from 20 pancreatic cancer patients, 10 chronic pancreatitis patients and 20 cancer-free controls from May 2007 to September 2008 was carried out by two-dimensional fluorescence electrophoresis (2D-DIGE). Differentially expressed proteins were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). The significance difference proteins were confirmed by Western-blot.

RESULTSA differentially expressed proteins: complement 3 (C3) was identified. The gray level of C3 in pancreatic cancer tissue, chronic pancreatitis, and normal control group were 1.63 ± 0.28, 0.65 ± 0.13 (t = 11.81, P = 0.00) and 0.88 ± 0.19 (t = 9.93, P = 0.00), respectively. C3 was high expression in pancreatic cancer group compared with normal control group. The expression of C3 was higher in pancreatic cancer group than in chronic pancreatitis group. The high expression of C3 in pancreatic carcinoma was confirmed by Western blot.

CONCLUSIONS2D-DIGE and MALDI-TOF-MS technology is a quick, easy and practical method to screen for specific biomarkers in serum of patients with pancreatic carcinoma. The identified protein C3 in this study may be as specific serum biomarkers of pancreatic carcinoma.

Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; blood ; Case-Control Studies ; Complement C3 ; analysis ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; blood ; diagnosis ; Pancreatitis, Chronic ; blood ; Proteomics ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Two-Dimensional Difference Gel Electrophoresis