Pancreatic Dysfunction: Symptoms, Causes & Potential Health Risks

Pancreas: Dual Function

• Exocrine (95%): Acinar cells → digestive enzymes (amylase, lipase, proteases) → duodenum.
• Endocrine (5%): Islets of Langerhans → insulin (β), glucagon (α), somatostatin (δ), pancreatic polypeptide (γ).

Major Disorders

Diagnostic Workup

• Lipase/amylase (acute pancreatitis: >3× ULN)
• Fecal elastase-1 (EPI: <200 µg/g)
• HbA1c, glucose tolerance (diabetes)
• CT/MRCP/EUS (structure, ducts, masses)
• CA 19-9 (monitoring PDAC)

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Condition	Key Features
Diabetes Mellitus	Type 1: Autoimmune β-cell destruction → absolute insulin deficiency. Type 2: Insulin resistance + relative deficiency. Both → hyperglycemia.
Acute Pancreatitis	Gallstones, alcohol, hypertriglyceridemia (>1000), drugs, ERCP, trauma → autodigestion. Ranson/APACHE scores predict severity.
Chronic Pancreatitis	Recurrent inflammation → fibrosis, calcification, exocrine insufficiency (steatorrhea), endocrine insufficiency (diabetes). Alcohol #1 cause.
Pancreatic Cancer (PDAC)	Adenocarcinoma (90%); late presentation (jaundice, weight loss, pain); 5-yr survival ~12%. Risk: smoking, obesity, chronic pancreatitis, BRCA, Lynch.
Exocrine Pancreatic Insufficiency (EPI)	Inadequate enzymes → maldigestion → steatorrhea, weight loss, fat-soluble vitamin deficiency. Causes: CP, CF, pancreatic resection, pancreatic cancer.
Pancreatic Neuroendocrine Tumors (pNETs)	Functional (insulinoma, gastrinoma/ Zollinger-Ellison, glucagonoma) or non-functional. Variable malignancy.