Pancreatic neuroendocrine neoplasms

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Pancreatic neuroendocrine neoplasms

Endocrine system


Pancreatic neuroendocrine neoplasms


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Pancreatic neuroendocrine neoplasms

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A 47-year-old woman comes to the physician due to midline abdominal pain that has been ongoing for several months. The pain is described as a burning sensation and worsens after meals. As a result, the patient has been eating less and has experienced a 5 kg (11 lb) weight loss. She has a history of peptic ulcer disease, which was diagnosed last year. She was prescribed omeprazole but has not noticed an improvement in symptoms after initiating therapy. Medical history is also notable for low back pain. Vitals are within normal limits. Physical examination reveals mild tenderness to palpation of the epigastric region. An endoscopy is performed and shows multiple ulcers in the stomach and duodenum. A urea breath test is negative. Administration of intravenous secretin is followed by an increase in serum gastrin levels by 200 pg/mL. Which of the following is the most likely cause of this patient’s symptoms?  

External References

First Aid



With pancreatic neuroendocrine neoplasms, neuroendocrine refers to pancreatic cells which release hormones in response to signals from the nerves, and neoplasm refers to a cancer.

So, pancreatic neuroendocrine neoplasm is a cancer of neuroendocrine cells that are within the pancreas.

They can also be called pancreatic neuroendocrine tumors, or just panNETs for short.

In addition to endocrine cells, the pancreas also has exocrine cells, which make up a majority of the gland.

Most pancreatic cancers arise from exocrine cells and they’re called adenocarcinomas, whereas only a minority arise from panNETs.

The pancreas is a long, skinny gland the length of a dollar bill which sits to the left of the duodenum and behind the stomach, in the upper abdomen, or the epigastric region.

It plays two main roles - there’s the exocrine part of the pancreas which has acinar cells that make digestive enzymes that are secreted into the duodenum to help digest food.

There’s also the endocrine part of the pancreas which has a few different types of islet cells, or neuroendocrine cells, each of which make different hormones.

These neuroendocrine cells are present in clusters, or islands, called islets of Langerhans.

The largest group of cells are the beta (β) cells which secrete insulin.

Insulin mainly lowers the blood glucose levels by transporting glucose into the cells, and also pushes potassium into cells, which decreases potassium in the blood.

Another group are the alpha (α) cells which secrete glucagon, a hormone that does exactly the opposite of insulin, it raises the blood glucose levels by getting the liver to generate glucose from amino acids and lipids, and to break down glycogen into glucose.

There are also Delta cells which secrete somatostatin, which decreases the release of other hormones, including insulin, glucagon, and serotonin.


Pancreatic neuroendocrine Tumors (PNETs) are a type of tumor that arises in the endocrine tissue of the pancreas. These tumors include insulinomas, gastrinoma, glucagonoma, and VIPomas, and secrete hormones including insulin, gastrin, glucagon, and vasoactive intestinal peptide respectively. Symptoms of PNETs may include abdominal pain, weight loss, and changes in bowel habits. Treatment options may involve drugs like somatostatin and surgery.


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  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "The Pathologic Classification of Neuroendocrine Tumors" Pancreas (2010)
  6. "Update on pancreatic neuroendocrine tumors" PubMed (2014)

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