PANCREATIC ISLET TUMORS
The
pancreas contains the islets (islands) of Langerhans, small nests of cells that
secrete directly into the bloodstream and there-fore are part of the endocrine
system. The hormone insulin is essential for the metabolism of glucose.
Diabetes mellitus is the result of
deficient secretion of insulin.
At
least two types of tumors of the pancreatic islet cells are known: those that
secrete insulin (insulinoma) and those in which insulin secretion is not
increased (“nonfunctioning” islet cell cancer). Insulinomas produce
hypersecretion of insulin and cause an excessive rate of glucose metabolism.
The resulting hypo-glycemia may produce symptoms of weakness, mental confusion,
and seizures. These symptoms may be relieved almost immedi-ately by oral or
intravenous administration of glucose. The 5-hour glucose tolerance test is
helpful in diagnosing insulinoma and in distinguishing it from other causes of
hypoglycemia.
When a
tumor of the islet cells has been diagnosed, surgical treat-ment with removal
of the tumor usually is recommended. The tumors may be benign adenomas or they
may be malignant. Complete removal usually results in almost immediate relief
of symptoms. In some patients, symptoms may be produced by simple hypertrophy
of this tissue rather than a tumor of the islet cells. In such cases, a partial
pancreatectomy (removal of the tail and part of the body of the pancreas) is
performed.
In
preparing the patient for surgery, the nurse must be alert for symptoms of
hypoglycemia and be ready to administer glucose as prescribed if symptoms
occur. Postoperatively, the nursing man-agement is the same as that after other
upper abdominal surgical procedures, with special emphasis on monitoring serum
glucose levels. Patient teaching is determined by the extent of surgery and the
alterations in pancreatic function that result.
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