Chapter 345 Pancreatic Tumors
Pancreatic tumors can be of either endocrine or nonendocrine origin. Tumors of endocrine origin include insulinomas and gastrinomas. These and other functioning tumors occur in the autosomal dominantly inherited multiple endocrine neoplasia type 1 (MEN-1). Hypoglycemia accompanied by higher than expected insulin levels or refractory gastric ulcers (Zollinger-Ellison syndrome) indicate the possibility of a pancreatic tumor (Chapter 337). Most gastrinomas arise outside of the pancreas. The treatment of choice is surgical removal. If the primary tumor cannot be found or if it has metastasized, cure might not be possible. Treatment with high dose of a proton pump inhibitor to inhibit gastric acid secretion is then indicated.
The watery diarrhea-hypokalemia-acidosis syndrome is usually produced by the secretion of vasoactive intestinal peptide (VIP) by a non–α-cell tumor (VIPoma) (see Table 333-7
