Diagnosis and treatment of pancreatic insufficiency in children. Disorders of the exocrine function of the pancreas in children

The pancreas performs important functions in the body that ensure the normal functioning of the body. Like any intraorganic structure, the pancreas can undergo some kind of pathological influences, which is why its functionality is reduced. One such pathological condition is pancreatic insufficiency.

Reason for development

The pancreas is engaged in the production of specific digestive enzymes, in the absence of which the normal course of food digestion is impossible.

When failures occur in the production of these substances and the gland begins to function defectively, then such a condition is called pancreatic insufficiency.

There are several causes of pancreatic insufficiency. These include:

  • vitamin deficiency;
  • Damage to the pancreas
  • Lack of hemoglobin;
  • Lack of protein in the blood;
  • Unhealthy diet, abuse of salty foods, fatty foods, unusual seasonings, spices, etc .;
  • Heredity;
  • Pathologies like lipomatosis, cystic fibrosis, Shwachman's syndrome;
  • The death of gland cells against the background of pancreatitis or surgical removal parts of an organ.

Sometimes there are several factors that provoke the development of pathology. Or it may be that the patient seems to be healthy, leads a healthy lifestyle, eats properly, but pancreatic insufficiency is still detected. In such situations, usually the reasons lie in hereditary predisposition.

Varieties of the disease: causes, symptoms, diagnosis and treatment methods

Specialists distinguish four types of functional pancreatic insufficiency, and each of them has its own individual characteristics, up to the etiology or method of treatment.

Pancreatic insufficiency can be:

  • exocrine;
  • Exocrine;
  • Enzymatic;
  • Endocrine.

Since each of the varieties has serious differences, then they must be considered separately.

Exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency is a pathology in which there is a lack of juices for the stable course of digestive processes. The characteristic signs of such pancreatic insufficiency are:

  1. nausea reactions;
  2. Bloating
  3. Feeling of heaviness in the epigastrium;
  4. stool problems;
  5. Poor digestion.

This pathological condition is preceded by various gastric problems and pathologies of the pancreas, caused by changes in the glandular tissues. In addition, exocrine insufficiency can develop against the background of gallbladder or intestinal diseases, excessive starvation or abuse of mono-diets.

It is possible to identify exocrine insufficiency only through a comprehensive laboratory diagnostics. With such pancreatic insufficiency, the risk of developing diabetes increases, so such patients should regularly check the blood for sugar content.

The success of treatment directly depends on the exact establishment of the etiology of the pathological process. With a dietary or alcohol factor, you will need to change your lifestyle, abandoning strict diets and drinking alcohol.

In the diet with a similar form of pancreatic insufficiency, vitamins such as ascorbic acid, tocopherol and retinol must be present. In addition, patients are prescribed enzymatic preparations that help the gland to fully perform secreting functions.

Exocrine

Today, even relatively young patients suffer from insufficiency of the secretory type. This form is closely related to exocrine, because insufficient production of enzyme components leads to disruption of digestion processes in the intestine.

The reason for the lack of secretion is a variety of factors, under the influence of which the pancreas loses some of the cells that produce the most important pancreatic secretion.

Also contribute to the development of pathology reception of certain medications, excessively active outflow of pancreatic secretion into the 12-colon intestine, poor participation of enzyme substances in the processing of food masses or a decrease in the parenchyma of the organ.

Exocrine pancreatic insufficiency is characterized by specific symptoms, among which there are manifestations like:

  • Heaviness in the abdomen that occurs after eating high-fat foods;
  • Intolerance to spicy or overly fatty foods;
  • Mushy, greasy stools;
  • Pain in the bones;
  • Colic;
  • Flatulence.

Patients with similar insufficiency often complain of shortness of breath, dryness skin, palpitations, blood clotting disorders, etc. Such complaints are due to the fact that the body lacks fats, which are practically not absorbed from food.

Treatment involves the correct diet, while you need to reduce a single meal to a minimum, but eat up to 5-6 times a day. It is necessary to somewhat limit the intake of fatty foods, which are still not digested. You should also avoid eating at night and late in the evening.

Alcoholic products are under an absolute ban. The list of allowed dishes must be clarified with a doctor.

The diet should be enriched with plant-based foods such as vegetables, grains, and fruit crops that are rich in complex carbohydrates. Against the background of plant nutrition, gas formation may increase, which bran will help to cope with.

Drug therapy for exocrine pancreatic insufficiency involves taking drugs that help the gland to function fully. Such medicines include, Pancreatin, Creon, etc. The first sign of the correctness of treatment will be the elimination of diarrhea and the normalization of results laboratory research stool masses.

Enzymatic

Enzyme deficiency is called food intolerance, which develops against the background of insufficient exocrine pancreatic functionality.

Enzymes are present in pancreatic juice, their purpose is to help the food masses to be digested.

If at least one enzymatic component is not enough, then the entire digestive process will go astray and break down.

Usually provoke such insufficiency of the pancreas factors like:

  1. infectious processes;
  2. Reception medicines leading to damage to glandular cellular structures;
  3. Lesions of the ductal channels of the pancreas;
  4. Congenital structural pathologies of the organ, etc.

characteristic clinical manifestations pancreatic enzyme deficiency problems with appetite and pain in the abdomen, nausea or excessive gas formation, liquid stool and chronic fatigue, weak physical activity and weight loss.

One of characteristic features Deficiency of the enzyme type is considered to be liquefaction of the stool, which has a greasy texture and a fetid odor.

For diagnosis, the patient is prescribed research, and. Based on the data obtained, the exact form of insufficiency is revealed.

In case of enzyme deficiency, high-calorie nutrition and medication are indicated to help digestion processes.

Endocrine

Another form of insufficient functionality of the pancreas is endocrine or intrasecretory.

The main tasks of the endocrine function is the production of hormonal substances such as glucagon, lipocaine or insulin. If this function fails, the consequences for the body will be irreparable.

A similar form of insufficiency usually develops against the background of lesions of those glandular areas (islets of Langerhans), which are responsible for the production of a certain hormonal substance. With such lesions, the almost inevitable threat of developing diabetes looms over the patient.

Endocrine insufficiency of the pancreas is manifested by such appearances as:

  • The fetid smell of the emitted gases;
  • Nauseous-vomiting reactions;
  • Bloating and diarrhea with foul-smelling stools;
  • Increased bowel movements;
  • Laboratory blood tests will show the presence of abnormalities.

In addition, there are also symptoms of a concomitant nature, such as a general malaise of the patient that occurs against the background of dehydration due to diarrhea.

Diagnosis is similar to other forms of pancreatic insufficiency.

After establishing an accurate diagnosis, the patient is prescribed the strictest diet therapy aimed at minimizing glucose in the blood. When useless diet food treated with insulin injections.

It is quite possible to live with this form of insufficiency, but the strictest dietary diet should become the norm of life without any exceptions or concessions.

Forecasts

According to statistics, more than 30% of the population has some form of pancreatic insufficiency. Someone knows about their pathology and has already taken measures to eliminate it, while someone is ignorant, which only aggravates the situation.

The main thing is that in the presence of any pancreatic insufficiency, strictly follow dietary recommendations and take prescribed drugs according to the prescribed scheme.

Of course, such a disease for any person is associated with very unpleasant sensations, but if the patient gives up unhealthy habits and unhealthy nutrition, then the quality of life increases and the disease stops.

If a patient, on the background of alcohol dependence, has earned pancreatic insufficiency, then with a complete refusal to drink alcohol, he will be able to live for about 10 more years.

If, however, the patient continues to abuse alcohol and eat prohibited foods, then in a few years he will be provided with fatal outcome. Therefore, a healthy lifestyle and a diet with such a diagnosis is not just a whim of a doctor, but a guarantee of saving life.

Video about exocrine pancreatic insufficiency:

Pancreatic insufficiency is a deficiency of pancreatic enzymes that interferes with the normal digestion of food and the absorption of nutrients.

Causes

The causes of pancreatic insufficiency can be congenital (cystic fibrosis, lipomatosis, Shwachmann's syndrome) and acquired (surgical removal of the pancreas, cell death due to pancreatitis).

The progressive loss of acinar gland cells inevitably leads to impaired absorption due to inadequate production of digestive enzymes. However, the significant functional reserve of the pancreas does not allow the symptoms of pancreatic insufficiency (PEI) to manifest until most of the pancreas has been destroyed. Pancreatic enzymes perform basic digestive functions, but there are alternative routes for the digestion of certain nutrients. In the process of experimental blocking of pancreatic secretion in the intestine, they continued to assimilate up to 63% of the incoming proteins and up to 84% of fats. This limited enzymatic activity is likely due to lingual and/or gastric lipases, gastric pepsins, intestinal mucosal esterases and peptidases, and, in young patients, bile salt-activated milk lipase. However, in severe violation exocrine function in the pancreas, these alternative digestion pathways are deficient, resulting in signs of impaired absorption. PEI is less common in children than in adults, but more reliable TPI tests designed for children have shown that the disease is much more common than previously thought.

Spontaneous development of atrophy of pancreatic acinar cells, PAA (from the English pancreatic acinar atrophy) in previously healthy adult patients is quite common and is the main cause of EPI. Similar disorders occur periodically in children, there are known cases of identical histologically confirmed pathological changes. Recent studies have shown that some people develop AAD as a consequence of asymptomatic lymphocytic and possibly autoimmune pancreatitis. These patients do not develop diabetes because the islet cells are preserved.

Based on the results of standard laboratory tests, it is usually not possible to make a diagnosis of PEI. Alanine aminotransferase (ALT) activity may be mildly or moderately elevated, possibly reflecting hepatocyte damage caused by overabsorption of hepatotoxic substances due to impaired mucosal permeability small intestine. The results of other biochemical studies of blood serum are not pathognomonic, except that a decrease in the level of total fats, cholesterol and polyunsaturated fatty acids is often detected. The concentration of protein in the blood serum usually remains normal, despite a pronounced violation of the supply of nutrients to the patient's body. Lymphopenia and eosinophilia may also be seen; however, if any other changes in the blood are detected, the possibility of the presence of other concomitant or alternative diseases should be considered.

The activity of amylase, isoamylase, lipase and phospholipase A 2 in the blood serum in EPI decreases minimally, indicating that in this type of patients these enzymes are secreted not only by the pancreas. The most reliable and widely used test currently is the assessment of TPI in serum.

Trypsinogen is synthesized only by the pancreas, and measurement of the serum concentration of this proenzyme using species-specific radioimmunoassays is the most reliable proxy for exocrine pancreatic function. The assessment of TPI in blood serum is a highly sensitive and specific method for diagnosing EPI, since the concentration of trypsinogen is significantly reduced compared to that in healthy patients and patients with diseases of the small intestine. Pronounced weakening of TPI (up to<2 мкг/л) может даже предшествовать развитию потери массы тела и диареи. Метод прост в исполнении: все, что для этого требуется, — это однократное взятие крови с предва­рительным выдерживанием больного на голодной диете в течение нескольких часов. ТПИ в сыворотке крови очень стабильна, что позволяет отправить об­разец с курьером в лабораторию, где проводят подоб­ные исследования.

There are other tests used to diagnose EPI: assessment of proteolytic activity in feces using azoprotein, radial diffusion of enzymes in gelatin, specific assessment of pancreatic elastase in feces, bentyromide test (BT-PABA), change in plasma transparency after oral administration of fats and microscopic examination of feces. In many cases, the results of these tests turn out to be both false positive and false negative, so they are not recommended even as a rough screening test. Moreover, not all laboratories can carry out these tests, and even if there are places to perform them, they are inconvenient and expensive. If EPI is suspected, a TPI assessment is recommended.

Treatment of pancreatic insufficiency

Enzyme Replacement Therapy

In most patients, pancreatic insufficiency is successfully treated with the addition of enzymes, which are a dry extract of the pancreas, to each serving of food. The extract may have different bioavailability, be produced in many forms (tablets, capsules, powders, granules) and may contain various enzymes. The initial effective dose is usually approximately two teaspoons of extract powder per 20 kg of body weight at each meal. The extract should be added to food immediately before feeding. Usually, two feedings are enough for the patient to begin to increase body weight. Weight gain, as a rule, is 0.5-1.0 kg per week, diarrhea and other disorders, such as polyphagia, are eliminated within 4-5 days.

After a clinical improvement in the condition, patients will be able to independently choose the minimum effective dose of enzyme preparations to prevent the recurrence of the disease. The dose is selected individually for each patient, since the amount of the drug depends on the batch of extract and the need of the patient's body for additional administration of enzymes. This condition requires a minimum of one full teaspoon of enzymes added to each feed, but children may need less. For some, feeding 3-4 times a day is enough, while others may need five feedings. As an inexpensive alternative to the dry extract, chopped raw bovine or porcine pancreas (100-150 g per 20 kg body weight) can be used if these patients are found to be healthy according to the results of a mandatory post-mortem examination. This offal can be stored frozen at minus 20 ° C for three months without significant loss of enzyme activity.

To protect enzymes from destruction by the acidic environment of the stomach, a special enteric (enteric) coating has been developed, but these agents are often less effective than powdered pancreatic extract. This effect may be due to the selective retention of enteric-coated particles in the stomach during the entire period of food in it or, possibly, their rapid transit through the intestine, which prevents adequate release of enzymes in the proximal small intestine. In the future, it may be more effective to use drugs that have an enteric coating, but designed specifically for patients with pancreatic insufficiency. Also effective and cost-effective can be the use of new drugs containing fungal or gastric lipases that do not break down in an acidic environment. At the same time, the likelihood of the effect of such drugs for patients with suboptimal weight gain is small, as well as increasing the dose of enzymes more than recommended or prescribing cimetidine. These data indicate the possible participation in this process of other factors not related to the content of enzymes in the proximal small intestine.

Diet changes for pancreatic insufficiency

Even the appointment of optimal enzyme therapy does not allow to normalize the absorption of fats. patients easily compensate for this by increasing their food intake, which necessitates the regulation of this indicator in order to maintain ideal body weight. Some types of dietary fiber reduce the activity of pancreatic enzymes in vitro, therefore, dietary fiber containing a significant amount of indigestible fiber should be avoided. At the same time, a low-fat diet only reduces the calorie intake of pancreatic insufficiency, so this should also be avoided. In order to correct the residual deficiency of the digestive function, it is advisable to use feeds containing a large amount of digestible and a low amount of indigestible dietary fiber.

Prognosis for pancreatic insufficiency

Pathological processes that led to the development of EPI, as a rule, are irreversible, so treatment must be carried out throughout life. It is important to bear in mind that patients, in addition to replacement therapy with enzyme preparations, often require the appointment of vitamin B 12. Given the high cost of treatment, it is logical to periodically either repeat the TPI test or stop enzyme administration approximately every 6 months in order to assess whether clinical signs of the disease reappear or not. Acinar tissue has some ability to regenerate, so it is understandable that after pancreatitis or RAA, the remaining pancreatic tissue can regenerate to such an extent that even normal digestion is possible. Cases of recovery from clinically pronounced enzyme deficiency have been described. However, in most cases, treatment is required throughout the patient's life, and if they are willing to carry out expensive enzyme replacement therapy for pancreatic insufficiency, the prognosis in this case is quite satisfactory. In some patients, the restoration of the previous body weight does not occur, but they do not have diarrhea and polyphagia, which significantly improves the quality of life. A high incidence of mesenteric torsion and dilatation/volvulus of the stomach has been described in Finland, but not in other countries.

The article was prepared and edited by: surgeon

Pancreatic insufficiency in children occupies a leading position among the pathology of the digestive tract, is distinguished by a variety of causes and clinical manifestations. They are largely explained by the anatomical location: the gland occupies a central position in the abdominal cavity, part of it is retroperitoneal (retroperitoneal), the head is in close contact with the duodenum, the tail is located at the hilum of the spleen.

Causes of pathology in a child

The pancreas is the only organ with a dual function - internal and external secretion:

  • produces pancreatic juice containing enzymes and biologically active substances;
  • synthesizes insulin and glucagon, which are involved in carbohydrate metabolism and affect the microcirculation of other organs and systems.

Due to the variety of functions and the participation of the pancreas in many processes in the body, a violation of its activity can be caused by various reasons:

  • improper diet and junk food;
  • abdominal trauma;
  • stress and chronic psycho-emotional overstrain;
  • infections (viral and bacterial).

Despite the various causes leading to disruption of the pancreas, the clinical picture in all cases has similar symptoms: both in the inflammatory process and in enzyme deficiency not associated with inflammation.

Pancreatic insufficiency in children is primary and secondary.

Primary causes non-modifiable factors (neither the doctor nor the patient can change them). These are certain diseases or pathological conditions:

  • congenital obstruction of the common pancreatic duct;
  • , genetically determined;
  • insufficient synthesis of certain enzymes - deficiency of lipase or trypsin due to pancreatic dysfunction.

Children mainly develop secondary gland failure (pancreatopathy, dyspancreatism).

Causes of a pancreatic rupture in a child include:

  • unhealthy food;
  • binge eating;
  • temporary decrease in the functions of the gland.

Inflammatory diseases of neighboring digestive organs lead to secondary insufficiency:

  • gastroduodenitis;
  • cholecystitis;
  • biliary dyskinesia.

Diagnostic measures

Disturbed pancreatic function is manifested by all the typical symptoms: pain, nausea, decreased appetite, diarrhea. In some cases, clinical manifestations may be absent for a long time. But in the future, this leads to pronounced changes in the digestive process.

Diagnosis of such conditions presents certain difficulties due to the vagueness of manifestations and minor changes in functional examination methods.

If a child complains of nausea, refuses to eat, he has abdominal pain, vomiting, and the whole range of symptomatic therapy is used.

Medical treatment

Medical treatment consists in carrying out. New drugs aimed at performing this function allow you to consume the amount of fat required for age, and the lack of lipase is compensated by an adequate dosage of the drug. This improves nutritional status, which is important as children's bodies are constantly growing.

The enzymatic preparation is selected according to the pancreatin contained in it, which includes the main enzymes (lipase, amylase, proteases). Pancreatin, Festal, Mezim-forte and others are prescribed.

More effective is the use of Creon, which is available in the form of capsules containing microspheres in pH-sensitive shells. Thanks to this innovative form, microcapsules containing the enzyme begin to break down fats, carbohydrates and proteins in the duodenum, the pH-resistant shell prevents hydrochloric acid in the stomach from violating the integrity of the microspheres, they enter the lumen of the duodenum intact. Only there is the release of the enzyme.

Children's age is not a contraindication to the appointment of Creon. So that the baby can swallow the drug, the capsule is opened and the microspheres are given to drink with a small amount of water.

The advantages of modern enzyme preparations include:

  • the possibility of use at any age;
  • no side effects;
  • good tolerance.

The last point is especially important, because in some situations, substitution therapy is prescribed for life. Children with enzyme deficiency drugs need to be taken from several weeks to several months.

Creon has a wide range of indications, but the main purpose is to fill the exocrine insufficiency of the pancreas. The criterion for a correctly selected dose is the normalization of stool and a decrease in its frequency.

If there are diseases of the digestive system that led to pancreatic failure, it is recommended to take in parallel:

  • antispasmodics (Duspatalin);
  • prokinetics;
  • proton pump inhibitors.

All drugs are prescribed only by a pediatrician or gastroenterologist individually, taking into account the patient's condition.

Folk methods

Due to the complexity of the problem, the duration of treatment with enzymes, and the high likelihood of complications, doctors categorically do not recommend treating pancreatic insufficiency in children with alternative methods. This can provoke, which will become the impetus for clinical manifestations, even in cases of asymptomatic pathology.

Possible complications of the disease

Subject to the recommendations prescribed by the doctor and the correct daily routine, including the mandatory time limit in some products, they will not occur. Otherwise, exocrine pancreatic insufficiency will manifest itself as a vivid clinical symptomatology of pancreatitis and in the future will acquire a chronic course with exacerbations requiring hospital treatment.

Diet during illness

Diet in this pathology is an integral part of the treatment. It cannot be violated even when taking replacement therapy.

Sometimes experts prescribe dietary restrictions for a year or more. In order not to disrupt the balance achieved by the treatment, it is necessary to observe the diet:

  • mechanically and chemically sparing food;
  • temperature regime - food should be warm;
  • fractional intake (5-6 times a day) in small portions;
  • limiting too fatty, fried, smoked and spicy foods;
  • intake of a sufficient amount of liquid (carbonated drinks, strong tea, coffee are prohibited);
  • compliance with the intervals between meals and the time of its intake.

In order not to have to treat and limit the child's food, parents need to carefully monitor the baby's digestion. Timely access to a specialist and treatment of pathological abnormalities will prevent the development of chronic diseases. Compliance with the daily routine, proper food intake will help to avoid problems with the health of children.

Bibliography

  1. Belmer S.V. Problems of digestive insufficiency: definition, detection, correction. Russian Medical Journal. 2003, No. 3, vol. 11, pp. 119–121.
  2. Netsvetaev A.V. Surgical pathology of the pancreas in children (clinic, diagnosis, treatment). Dissertation abstract.
  3. Korovina N.A., Zakharova I.N., Malova N.E. Exocrine pancreatic insufficiency: problems and solutions (a guide for physicians). M. 2004
  4. Korotko G.F. Secretion of the pancreas. 2nd revised edition. Publishing house of the Kuban State University 2005
  5. Belmer S.V., Gasilina T.V., Zavalin P.A., Kovalenko A.A. Exocrine pancreatic insufficiency in children: methods of diagnosis and correction (methodological aspects). M. 2001

Pancreatic insufficiency is a consequence of the destruction of its parenchyma. The functional tissues of the pancreas are destroyed, and connective tissue takes their place. It cannot produce enzymes and hormones, but only serves as a frame for the organ, giving it volume.

exocrine insufficiency

The pancreas produces internal and external secretions. The internal secret is hormones that enter the bloodstream and regulate metabolism. The external secret is the digestive juice, the main component of which are digestive enzymes. Exocrine insufficiency implies a violation of the exocrine function of the pancreas.

The essence of the diet for pancreatic insufficiency can be:

  • Primary. It occurs more frequently. Caused by the death of functioning pancreatic cells
  • Secondary. The secret is produced, but cannot enter the intestine due to obstruction of the pancreatic ducts. It is most often caused by the deposition of stones or thickening of pancreatic juice.

Symptoms of exocrine pancreatic insufficiency are mainly associated with impaired digestion and absorption of food in the intestine. First of all, the breakdown of fats suffers, since other organs take over the function of digesting proteins and carbohydrates. Symptoms of exocrine insufficiency include:

  • fat in stool
  • nausea after eating
  • progressive weight loss
  • abdominal pain
  • severe bloating

Correction of exocrine insufficiency

Primary exocrine pancreatic insufficiency cannot be eliminated. If the cells of an organ have died, then it will not be possible to restore them. When the pancreas is more than half composed of scars and fat, even surgical methods cannot correct the situation. At the same time, secondary pancreatic insufficiency can be corrected. Sometimes for this they resort to endoscopic operations, and it happens that conservative treatment is enough.

Primary exocrine insufficiency is more common. It in most cases is a consequence of acute or chronic pancreatitis. The main goal of treatment is to provide the patient with an acceptable quality of life. Considering that the pancreas is no longer able to fully perform its functions, pancreatin replacement therapy is prescribed, as well as a diet that reduces the load on the organ.

The essence of the diet for pancreatic insufficiency:

1. Fractional nutrition The organ affected by the pathological process is not able to cope with the digestion of large volumes of food, so the patient should consume it in small portions.

2. Prohibition of alcohol Alcoholic drinks destroy the pancreas, can provoke an exacerbation of chronic pancreatitis and lead to the development of complications.

3. Fat restriction The pancreas is the most difficult to cope with the digestion of fat, so its amount in the diet should be minimal.

Pancreatin preparations are used for replacement therapy. They contain digestive enzymes derived from the pancreas of pigs or bulls. These medicines are taken with food. They improve digestion, as they perform the same functions as the enzymes produced by the pancreas.

endocrine insufficiency

The pancreas performs not only exocrine, but also endocrine functions. It consists in the secretion of hormones that regulate metabolism. The main pancreatic hormones are insulin and glucagon. Endocrine insufficiency is usually accompanied by a deficiency of insulin, an anabolic hormone whose most important function is to transport glucose from the blood to the cells of the body.

Symptoms of endocrine pancreatic insufficiency:

  • high blood glucose after eating
  • thirst
  • increased diuresis

This condition is called pancreatogenic diabetes mellitus. It develops in 20-25% of patients with chronic pancreatitis, usually at least 10 years after the onset of the disease. The disease progresses gradually. The patient may need insulin or hypoglycemic drugs.

Sometimes secondary endocrine pancreatic insufficiency occurs. It occurs during acute pancreatitis or during an exacerbation of chronic inflammation of the pancreas. This insulin deficiency is temporary. It resolves on its own after a course of treatment for pancreatitis.

Glucagon deficiency is much less common. Its symptoms:

  • attacks of weakness, dizziness, tremors in the limbs, which can last from several hours to several days
  • mental disorder (depression, anxiety, restlessness)
  • sometimes muscle cramps
  • during seizures, depression or loss of consciousness is possible

Unfortunately, such patients often end up not with an endocrinologist, but with a psychiatrist. Diagnosis of pancreatic insufficiency, accompanied by a decrease in glucagon secretion, is very difficult.