this is a brief video on functional pancreatic neuroendocrine tumors these tumors are also called islet cell tumors because they arise from the endocrine pancreas or the islet cells the islets of Langerhans in the pancreas and they actively secrete hormones to have systemic effects when we talking about gastro nomás insulin Amma's glucagon ouma's v.i.p Oma's and somatostatin ouma's here we have an image of salt-and-pepper chromatin which is indicative of neuro endocrine differentiation not necessarily specific to a neuroendocrine tumor and not necessarily specific to one of these five neuroendocrine tumors but still shows neuro endocrine differentiation nonetheless so let's start talking about a gastronomic gastronome a-- is the second most common peanut it's by definition a gastrin secreting tumor of the endocrine pancreas and can also occur in the duodenum in the GI tract so those are the two places you might see a gastro Noma gastrin of course induces gastric acid secretion it's a hormone that induces gastric acid secretion gastrin normally comes from the G cells that are not found in the endocrine pancreas so it's a little strange that they're there but the cells in the endocrine pancreas can develop gastrin and form a gastronome oh these this exhaustion is or this endogenous production of gastrin causes recurrent ulcers in the stomach duodenum and jejunum and usually don't get ulcers as far down as the jejunum so having ulcers down there can be a sign of a gastronome it's a little more specific then ulcers in the stomach and the duodenum for gastronome a' these ulcers typically don't respond to conventional therapy that you would that you would give for normal stomach ulcers not as a result of gastronome our patients present with abdominal pain and diarrhea and these gastronomes cannot be suppressed by secretin which normally inhibits gastrin release and you also see high blood gastrin levels to diagnose you can treat gastronomes with somatostatin synthetic forma somatostatin is called octreotide you can also surgically resect the parts of the endocrine pancreas that are secreting gastrin these collection of sometimes is called zollinger-ellison syndrome and that's kind of a word that you should associate with a gastronome or abnormal secretion of gastrin next we have insulin Emma's and similar neuromas are the most common p-nut they are by definition insulin secreting tumors of the endocrine pancreas and they specifically come from the beta cells of the endocrine pancreas they present with hypoglycemia symptoms because you have too much insulin being released and these symptoms include hunger nervousness sweating lethargy confusion and coma to know if you have a lot of insulin going on to know if you have hypoglycemic going on you can also even often refer to Whipple's triad which is three symptoms three three three categories three criteria you must meet to know that you have too much insulin as a result of your hypoglycemia these three criteria are that you have hypoglycemia by blood test that's a sugar below 55 you have symptoms of hypoglycemia like those listed above hunger nervousness sweating progressing to lethargy confusion coma and these symptoms should correct with administration of glucose these three criteria can be met to know that you have Whipple's triad which tells you that you have hypoglycemia in this case as a result of insulinoma blood work for a person with insulinoma shows low glucose high insulin and high C peptide this last one high C peptide is important because it allows you to rule out exogenously sub insula and exogenous injection of insulin which would present with low glucose high insulin and low C peptide so that last one's a differentiating factor on the pathology you usually see small cells and you can treat insulinoma with surgical resection next up is a glucagon oma which is a rare tumor it's often malignant it's by definition of glucagon secreting tumor of the endocrine pancreas this time coming from the alpha cells of the endocrine pancreas blood work here shows increased kunnen as you might expect and often increased glucose as a result of that or Guga presents with a bunch of these you get mild diabetes you get dermatitis this is a hermetic rash called neuroleptic migratory erythema commonly seen around the groin area nasty looking rash you see decreased weight you see decreased red blood cells or anemia uses a venous thrombosis or deep vein thrombosis DVT so a bunch of DS indicate glucagon oma you can treat this one also with somatostatin or octreotide or surgical resection next is VIP OMA this is also known as Verner Morrison syndrome same collection of symptoms rare tumor most are malignant the VIP oma is by definition of VIP secreting tumor of the endocrine pancreas this time coming from the d1 cells let's remind ourselves that vasoactive intestinal peptide VIP is a hormone and it's normal role in the gut is to stimulate secretion of water and electrolytes so we can imagine that somebody with a VIP I want somebody with too much VIP is gonna present with with explosive and profuse watery diarrhea if you have excessive secretion of water and electrolytes into the gut you're going to get explosive watery diarrhea this results in low hydrochloric acid low potassium and also dehydration all of that makes sense too lastly we have somatostatin tomo also a rare tumor most of these are also malignant somatostatin is secreted from these tumors of the endocrine pancreas that's a definition of somatostatin oma this time it comes from the d or delta cells so insulinoma came from the beta cells glucagon oma came from the alpha cells VIP oma came from the d1 cells so medicine oma comes from the D cells some medicine inhibits a bunch of hormones throughout the body including gastrin cholecystokinin secretin modal in VIP GIP and entero glucagon so tamayo seddon is known as the universal inhibitor and inhibits a bunch of stuff so because of that it can present with a with a variety of symptoms including mild diabetes gall stones stay at areia and hypochloride ria which is again low HCL to treat this one you use some s statin to try to reverse the effects it's also worth mentioning some less common peanuts that you might find in the body these includes ACTH Ouma CR hm calcitonin Ouma CH RH Ouma CRF Ouma parathyroid hormone-related peptide tumours these are tumors that secrete that peptide that kind of acts like PTH called PT h RP parathyroid hormone-related tumor and lastly here's a slide to review from Wikipedia a very helpful slide that tells you about the multiple endocrine neoplasia AHS that might be relevant to some of these exocrine or these summits of these endocrine tumors these would mostly fit in with the pancreatic tumors of men1 and that's that's a an association worth knowing for most of these endocrine tumors this has been a review of endocrine tumors I hope it was helpful and thank you for listening