Symptoms of pancreatic hypofunction

An endocrine pancreatic hypofunction has very variable symptoms depending on the cause. If the hypofunction is based on the destruction of endocrine cells by autoantibodies (diabetes mellitus type 1), the symptoms often occur suddenly and sometimes develop into a life-threatening situation within hours. Those affected usually complain of outbreaks of sweating, a greatly increased urge to urinate and such a strong thirst that they sometimes drink more than five litres of fluid a day!

Since acute endocrine pancreatic hypofunction can lead to diabetic coma and eventually even death, emergency medical assistance must be called immediately in the event of such symptoms. If, on the other hand, endocrine hypofunction of the pancreas is the result of age-related weakening of the organ, it is usually a long-term process that can last for months or years. The tricky thing about it is that the affected persons usually do not feel any symptoms at all, while the blood sugar level, which is elevated due to the hypofunction, can already do its mischief (e.g. damage to blood vessel walls or nerves).

Since an exocrine pancreas hypofunction no longer produces sufficient digestive enzymes, some of the nutrients supplied in food are excreted undigested. The undigested fat, for example, is excreted with the stool, making it unusually light and malodorous. This is known as fatty stool.

In some cases, chronic diarrhoea, abdominal pain and flatulence also occur. In addition, fat in food often causes nausea and vomiting. Since not only fat but also the other nutrients cannot be digested completely, weight loss or, in children, inadequate weight gain (“failure to thrive”) eventually occurs. Over time, some people develop an increased tendency to bleed, which is manifested by frequent nosebleeds or a tendency to develop unusually large bruises. This is due to the reduced absorption of vitamin K. Since exocrine pancreatic hypofunction is often triggered by an inflammation of the pancreas (pancreatitis), some patients are also the first to feel the symptoms of this inflammation: A typical symptom is a belt-shaped pain in the upper abdomen which can radiate into the back.

Treatment

The treatment of endocrine pancreatic hypofunction (diabetes mellitus) aims to normalise blood sugar levels. In the case of type 2 diabetes, oral therapy in the form of tablets is often possible, the most commonly used drug being metformin. In the meantime, however, there is a wide range of orally administered diabetes drugs, so that an individual decision should be made together with an internist (diabetologist) on the selection of the most suitable drug.

In more advanced cases and in diabetes mellitus type 1, the injection of insulin is unavoidable. There are various schemes for this purpose, from which the most suitable one should be selected together with the doctor. Schemes with very clearly defined injection times and quantities do not require a lot of thought on the part of the patient, but they do restrict him or her considerably in terms of diet and physical exercise.

Therefore, such schemes are often used for seniors. Younger patients, on the other hand, are often happier with so-called “intensified” regimens, which require more organisational effort but also offer greater flexibility. In the case of exocrine pancreatic hypofunction, the first priority is to eliminate the cause.

Alcohol consumption should therefore be reduced as much as possible or preferably stopped. If a gallstone is present, it must first be removed by appropriate measures. The subsequent treatment is based on the replacement of the insufficiently produced digestive enzymes.

For this purpose, an enzyme mixture called pancreatin obtained from the pancreas of pigs is available. Alternatively, there are also herbal preparations. In addition to the enzymes, fat-soluble vitamins A, D, E and K must also be replaced in more severe cases.