The endocrine system is a control system of ductless endocrine glands that secrete chemical messengers called hormones that circulate within the body via the bloodstream to affect distant organs. It does not include exocrine glands such as salivary glands, sweat glands and glands within the gastrointestinal tract. The field of medicine that deals with disorders of endocrine glands is endocrinology, a branch of the wider field of internal medicine.

 

The endocrine system consists of a number of ductless glands located in different parts of body, which produce chemical substances called hormones (from Greek word mean-ing 'to excite') directly into the bloodstream, which affect various body functions and activities. Each hormone has a specific role and a target tissue or a target organ to act upon. These target organs respond to the effects of hormones. The hormones are re-leased in very minute concentrations at a time, depending upon the body's require-ment. The hormones are poured directly into the bloodstream, from where they go to their target organs or tissues regulating their activity without affecting any other metabolic activities. The production and release of hormones is controlled by a regulating mechanism called feedback mechanism, which inhibits or accelerates the production of hormones so that overproduction or underproduction does not take place. Over-production (hypersecretion) and underproduction (hyposecretion) of the hormones occurs when this regulating mechanism is not operating well and can lead to many disorders in the body.

 

 

 

·        Thyrotropin-releasing hormone (TRH)

·        Gonadotropin-releasing hormone (GnRH)

·        Growth hormone-releasing hormone (GHRH)

·        Corticotropin-releasing hormone (CRH)

·        Somatostatin

·        Dopamine

 

 

 

·        GH (human growth hormone)

·        PRL (prolactin)

·        ACTH (adrenocorticotropic hormone)

·        TSH (thyroid-stimulating hormone)

·        FSH (follicle-stimulating hormone)

·        LH (luteinizing hormone)

·        Oxytocin

·        ADH (antidiuretic hormone)

·        Melatonin

 

·        Thyroxine (T4)

·        Triiodothyronine (T3)

·        Calcitonin

·        Parathyroid hormone (PTH)

 

·        Atrial-natriuretic peptide (ANP)

·        Gastrin

·        Secretin

·        Cholecystokinin (CCK)

·        Somatostatin

·        Neuropeptide Y

·        Insulin-like growth factor

·        Angiotensinogen

·        Thrombopoietin

·        Insulin

·        Glucagon

·        Somatostatin

 

 

·        Glucocorticoids - cortisol

·        Mineralocorticoids - aldosterone

·        Androgens (including testosterone)

·        Adrenaline (epinephrine)

·        Noradrenaline (norepinephrine)

 

·        Renin

·        Erythropoietin (EPO)

·        Calcitriol

·        Calciferol (vitamin D3)

 

·        Leptin

 

 

·        Androgens (testosterone)

 

1.    Estrogens

2.    Testosterone

·        Progesterone

 

·        Progesterone

·        Human chorionic gonadotrophin (HCG)

·        Human placental lactogen (HPL)

 

However, endocrine glands of major significance in the human body and also transcription are the pituitary gland, thyroid gland, parathyroid gland, adrenal gland, pancreas, thymus gland, testes (in males) and ovaries (in females).

 

 

 

 

 

The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea that sits in the small, bony cavity (sella turcica) at the base of the brain. Its posterior lobe is connected to a part of the brain called the hypothalamus via the infundibulum (or stalk), giving rise to the tuberoinfundibular pathway. The posterior lobe is thus derived from neural ectoderm while the anterior lobe is derived from oral ectoderm. The anterior pituitary lobe receives releasing hormones from the hypothalamus via a portal vein system. The pituitary gland secretes hormones regulating a wide variety of bodily activities, including trophic hormones that stimulate other endocrine glands. For a while, this led scientists to call it the master gland, but now we know that it is in fact regulated by releasing hormones from the hypothalamus. It is physically attached to the brain by the pituitary, or hypophyseal stalk connected with the median eminence.

 

The pituitary gland is divided into two sections: the anterior lobe (adenohypophysis) and the posterior lobe (neurohypophysis). The posterior pituitary is, in effect, a projection of the hypothalamus. It does not produce its own hormones, but only stores and releases the hormones oxytocin and antidiuretic hormone (ADH - also known as vasopressin).

 

 

1.    Growth hormone: It regulates general body growth, growth of bones, carti­lages, and also muscle growth.

 

2.    Adrenocorticotrophic hormone (ACTH): ACTH controls activity of ad­renal cortex to release glucocorticosteroid, especially cortisol.

 

3.    Thyroid-stimulating hormone (TSH) or thyrotropin: TSH controls the activity of thyroid gland and helps in the secretion of hormones.

 

4.    Follicle-stimulating hormone: In women, the follicle-stimulating hormone stimu­lates the development of ova in the Graafian follicles of ovary and also stimulates the secretion of estrogen by follicle cells. In male, it stimulates formation of sper­matozoa in testes.

 

5.    Luteinizing hormone (LH) or intersti­tial cell-stimulating hormone (ICSH): In females, it stimulates ovulation, for­mation and maintenance of corpus lu­teum, secretion of progesterone in the ovary, and prepares the uterus for im­plantation. In men, it stimulates devel­opment and activity of interstitial cells to produce testosterone and semen. (Note: Both LH and FSH are together called pituitary gonadotrophic hor­mones as they control the growth and activity of the gonads and the functions associated with them.

 

6.    Prolactin: Prolactin initiates and main­tains milk secretion by the mammary glands after childbirth.

 

 

I.     Antidiuretic hormone (ADH) or vaso­pressin: ADH regulates the amount of water passed by the kidneys. It also in­creases t he reabsorption of water by the kidneys and raises the blood pressure by constricting the peripheral blood vessels.

 

2.    Oxytocin: Oxytocin stimulates contrac­tion of a pregnant uterus during labor and childbirth. It also stimulates the milk expulsion from the mammary glands.

 

There is also an interaction between the hormones from the hypothalamus, i.e. TRH induces the release of prolactin. The control of release of hormones from the pituitary is in a negative feedback loop. Their release is inhibited by increasing levels of hormones from the target gland on which they act.

 

 

 

 

The thyroid is one of the larger endocrine glands in the body. It is located in the neck and produces hormones, principally thyroxine and triiodothyronine, that regulate the rate of metabolism and affect the growth and rate of function of many other systems in the body.

 

The thyroid is situated on the front side of the neck at the level of C5 to T1 vertebral bodies, just below the laryngeal prominence (Adam's apple), near the thyroid cartilage over the trachea but covered by layers of skin and muscle. The thyroid is one of the larger endocrine glands - 10-20 grams in adults- and butterfly-shaped: the wings correspond to the lobes and the body to the isthmus of the thyroid. It may enlarge substantially during pregnancy and when affected by a variety of diseases.

 

The thyroid gland is supplied by two pairs of arteries: the superior and inferior thyroid arteries of each side. The superior thyroid artery is the first branch of the external carotid, and supplies mostly the upper half of the thyroid gland, while the inferior thyroid artery is the major branch of the thyrocervical trunk, which comes off of the subclavian artery.

 

The thyroid is composed of spherical follicles that selectively absorb iodine (as iodide ions, I-) from the blood and for production of thyroid hormones. Twenty-five percent of all the body I- is in the thyroid gland. The follicles are made of a single layer of thyroid epithelial cells, which secrete T3 and T4. Inside the follicles is a colloid, which is rich in a protein called thyroglobulin. The colloidal material serves as a reservoir of materials for thyroid hormone production and, to a lesser extent, a reservoir of the hormones themselves. Scattered among follicular cells and in spaces between the spherical follicles are another type of thyroid cell, parafollicular cells or C cells, which secrete calcitonin.

 

The primary function of the thyroid is production of the hormones thyroxine (T4), triiodothyronine (T3), and calcitonin. Up to 40% of the T4 is converted to T3 by peripheral organs such as the liver and spleen.

 

Thyroxine is synthesized by the follicular cells from the tyrosine residues of the protein called thyroglobulin (TG). In the blood, T4 and T3 are partially bound to thyroxine-binding globulin, transthyretin and albumin. Only the free fraction (not bound to these proteins) has hormonal activity. The production of thyroxine is regulated by thyroid-stimulating hormone (TSH), released by the pituitary. The thyroid and thyrotropes form a negative feedback loop: TSH production is suppressed when the T4 levels are high, and vice versa. The TSH production itself is modulated by thyrotropin-releasing hormone, which is produced by the hypothalamus and secreted at an increased rate in situations such as cold (in which an accelerated metabolism would generate more heat). TSH production is blunted by somatostatin (SRIH).

 

Parafollicular cells produce calcitonin in response to hypercalcemia (not TSH, which stimulates thyroxine production). Calcitonin plays a role in the calcium metabolism; it is the functional opposite of parathyroid hormone, but exerts its influence mainly on bone. Its relatively small role is signified by the fact that after removal of the thyroid, calcium levels typically remain stable.

 

The significance of iodine-In areas of the world where iodine - essential for the production of thyroxine, which contains four iodine atoms - is lacking in the diet, the thyroid gland can be considerably enlarged, resulting in the swollen necks of endemic goitre. Iodized salt is a cheap and easy way of adding iodine to the diet. This has eliminated endemic cretinism in most developed countries, and some governments have made the iodination of flour mandatory.

 

 

Hyper- and hypofunction:

 

 

·        Hashimoto's thyroiditis / thyroiditis

·        Ord's thyroiditis

·        Postoperative hypothyroidism

·        Postpartum thyroiditis

·        Silent thyroiditis

·        Acute thyroiditis

·        Iatrogenic hypothyroidism

·        Thyroid storm

·        Graves-Basedow disease

·        Toxic thyroid nodule

·        Toxic nodular struma (Plummer's disease)

·        Hashitoxicosis

·        Iatrogenic hyperthyroidism

 

·        Goitre

·        Endemic goitre

·        Diffuse goitre

·        Multinodular goitre

·        Lingual thyroid

·        Thyroglossal duct cyst

·        Thyroid adenoma

·        Thyroid cancer

·        Papillary

·        Follicular

·        Medullary

·        Anaplastic

·        Lymphomas and metastasis from elsewhere (rare)

 

 

 

Hypothyroidism is the disease state caused by insufficient production of thyroid hormone by the thyroid gland. There are several distinct causes for chronic hypothyroidism, the most common being Hashimoto's thyroiditis and hypothyroidism following radioiodine therapy for hyperthyroidism.

 

The severity of hypothyroidism varies widely. Patients are classified as "subclinical hypothyroid" if diagnostic findings show thyroid hormone abnormalities, but they do not exhibit any symptoms.

 

·        Slowed speech and a hoarse, breaking voice

·        Impaired memory

·        Increased sensitivity to heat and cold

·        A slow heart rate and sluggish reflexes

·        Dry puffy skin, especially on the face, and hair loss, especially thinning of the outer 1/3 of the eyebrows

·        Depression (especially in the elderly)

·        Weight gain and obesity

·        Anemia

·        Slowed metabolism

·        Constipation

·        Fatigue

·        Choking sensation or difficulty swallowing

·        Shortness of breath

·        Increased need for sleep

·        Muscle cramps and joint pain

·        Decreased sex drive

·        Brittle fingernails

·        Paleness

·        Irritability

·        Abnormal menstrual cycles

·        Thin, fragile or absent cuticles

·        Infertility or difficulty becoming pregnant

·        Elevated serum cholesterol

 

 

1. Substitution of thyroid hormones by taking thyroxine (T4) tablets, usually in the form of levothyroxine. Doses are started with smaller amounts of thyroxine and then slowly titrated under control of TSH levels. Usually the maintenance dose is about 1 to 2 micrograms (µg) per kilogram of body weight.

2. Deficiencies of some dietary minerals and iodine can lead to hypothyroidism. Supplementation can be an effective treatment, but only if iodine deficiency has been documented.

3. Synthetic T3.

Hashimoto's thyroiditis, the most common form of thyroiditis, is an autoimmune disease where the body's own antibodies fight the cells of the thyroid. It is four times more common among women than men, and runs in families, with the HLADR5 gene most strongly implicated (conferring a relative risk of 3) in the UK. The genes implicated vary in different ethnic groups.

 

In many cases, Hashimoto's thyroiditis usually results in hypothyroidism, although in its acute phase, it can cause a transient hyperthyroid state. Treatment is by daily thyroxine, with the sodium salt of thyroxine liothyronine given when the need to raise levels of circulating thyroxine is urgent. Symptoms of Hashimoto's thyroiditis include symptoms of hypothyroidism and a goitre.

 

 

Hyperthyroidism (or "overactive thyroid gland") is the clinical syndrome caused by an excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both.

 

 

·        Graves' disease (the most common etiology with 70-80%)

·        Toxic thyroid adenoma

·        Toxic multinodular goitre

·        Other causes of hyperthyroxinemia (high blood levels of thyroid hormones) are not to be confused with true hyperthyroidism and include subacute and other forms of thyroiditis (inflammation). Thyrotoxicosis (symptoms caused by hyperthyroxinemia) can occur in both hyperthyroidism and thyroiditis. When it causes acutely increased metabolism, it is sometimes called "thyroid storm".

 

Major clinical features in humans are weight loss (often accompanied by a ravenous appetite), fatigue, weakness, hyperactivity, irritability, apathy, depression, polyuria, and sweating. Additionally, patients may present with a variety of symptoms such as palpitations and arrhythmias (notably atrial fibrillation), dyspnea, infertility, loss of libido, nausea, vomiting, and diarrhea.

 

A diagnosis is suspected through blood tests, by measuring the level of TSH (thyroid stimulating hormone) in the blood. If TSH is low, there is likely to be increased production of T4 and/or T3. Measuring specific antibodies, such as anti-TSH-receptor antibodies in Graves' disease, may contribute to the diagnosis. In all patients with hyperthyroxinemia, scintigraphy is required in order to distinguish true hyperthyroidism from thyroiditis.

 

 

Radioiodine-In Radioiodine (treatment) therapy, radioactive iodine is given orally (either by pill or liquid) on a one-time basis to ablate a hyperactive gland. The iodine given for ablative treatment is different from the iodine used in a scan. Radioactive iodine is given after a routine iodine scan, and uptake of the iodine is determined to confirm hyperthyroidism. The radioactive iodine is picked up by the active cells in the thyroid and destroys them. Since iodine is only picked up by thyroid cells, the destruction is local and there are no widespread side effects with this therapy.

 

Thyrostatics-are drugs that inhibit the production of thyroid hormones, such as methimazole (Tapazole®) or PTU (propylthiouracil).

 

 

Graves-Basedow disease is a form of thyroiditis, an autoimmune disorder that stimulates the thyroid gland, being the most common cause of hyperthyroidism (overactivity of the thyroid). Also known in the English-speaking world simply as Graves' disease, it occurs most frequently in women (8:1 compared to men) of middle age. Symptoms include fatigue, weight loss and rapid heart beat. Because similar antibodies to those stimulating the thyroid also affect the eye, eye symptoms are also commonly reported. Treatment is with medication that reduces the production of thyroid hormone (thyroxin), surgery thyroidectomy or with radioactive iodine if refractory.

 

 

A goitre is a swelling in the neck (just below Adam's apple or larynx) due to an enlarged thyroid gland. They are classified in different ways:

 

A "diffuse goitre" is a goitre that has spread through all of the thyroid (and is contrasted with a "simple goitre", "single thyroid nodule" and "multinodular goitre".

 

"Toxic goitre" refers to goitre deriving from inflammation, neoplasm, or malfunction of the thyroid, while "nontoxic goitre" refers to all other types (such as that caused by lithium or an autoimmune reaction.)

 

The most common cause for goitre in the world is iodine deficiency. Iodine is necessary for the synthesis of the thyroid hormones, triiodothyronine and thyroxine (T3 and T4). When iodine is not available, these hormones cannot be made. In response to low thyroid hormones, the pituitary gland releases thyroid stimulating hormone (TSH). Thyroid stimulating hormone acts to try and increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size as a type of compensation.

 

Goitre is more common among women. Treatment may not be necessary if the goitre is not caused by disease and is small. Removal of the goitre may be necessary if it causes difficulty with breathing or swallowing.

 

 

Thyroid cancer is cancer of the thyroid gland. There are four forms: papillary, follicular, medullary and anaplastic. The most common forms (papillary and follicular) are fairly benign, and the medullary form also has a good prognosis; the anaplastic form is fast-growing and poorly responsive to therapy.

 

Masses of the thyroid are diagnosed by fine needle aspiration (FNA) or frequently by thyroidectomy (surgical removal and subsequent pathological examination). As the thyroid concentrates iodine, radioactive iodine is a commonly used modality in thyroid carcinomas.

 

Thyroid cancers can be classified according to their pathological characteristics. The following variants can be distinguished:

 

·        Papillary thyroid cancer (75%, incl. mixed papillary/follicular)

·        Follicular thyroid cancer (16%)

·        Medullary thyroid cancer (5%)

·        Anaplastic thyroid cancer (3%)

·        Lymphoma (1%)

·        Squamous cell carcinoma, sarcoma (0.5 - 2%)

 

 

 

The parathyroid glands are small endocrine glands in the neck, usually located within the thyroid gland, which produce parathyroid hormone. Most often there are four parathyroid glands but have been known to number six or eight.

 

Parathyroid hormone is a small protein that takes part in the control of calcium and phosphorus homeostasis, as well as bone physiology. When blood calcium levels drop below a certain point, calcium-sensing receptors in the parathyroid gland are activated to release hormone into the blood. It then stimulates osteoclasts to break down bone and release calcium into the blood. The sole purpose of the parathyroid glands is to regulate the calcium level in our bodies within a very narrow range so that the nervous and muscular systems can function properly.

 

The single major disease of parathyroid glands is overactivity of one or more of the parathyroid lobes, which make too much parathyroid hormone causing a potentially serious calcium imbalance. This is called hyperparathyroidism; it leads to hypercalcemia and osteitis fibrosa cystica.

 

 

The adrenal glands (also known as suprarenal glands or colloquially as kidney hats) are the triangle-shaped endocrine glands that sit atop the kidneys. They are chiefly responsible for regulating the stress response through the synthesis of corticosteroids and catecholamines, including cortisol and adrenaline.

 

Anatomically, the adrenal glands are located in the abdomen, situated on the anterosuperior aspect of the kidneys. In humans, the adrenal glands are found at the level of the 12th thoracic vertebra and receive their blood supply from the adrenal arteries.

 

It is separated into two distinct structures, the adrenal medulla and the adrenal cortex, both of which receive regulatory input from the nervous system. As its name suggests, the adrenal medulla is at the center of the adrenal gland surrounded by the adrenal cortex.

 

The adrenal medulla is the body's main source of the catecholamine hormones epinephrine and norepinephrine.

 

The cortex produces a group of ste­roid hormones. These are glucocorticoids, mineralocorticoids, and gonadocorticoids.

 

1.    Glucocorticoids: Glucocorticoids regu­late the metabolism of carbohydrates, proteins, and fats. Various glucocorti­coids include cortisol, cortisone, and corticosterone. Of these, cortisol has the greatest activity. Secretion of the glucocorticoid hormones is regulated by the adrenocorticotrophic hormone (ACTH) secreted from the anterior pi­tuitary Glucocorticoids also regulate the concentration of glucose in the blood.

 

 

2.    Mineralocorticoids: Aldosterone is one of the major mineralocorticosteroids in human beings. It regulates the electro­lyte and water balance of the body. It maintains the homeostasis of sodium and potassium in the body It promotes reabsorption of sodium by the kidneys into the blood and excretion of potas­sium by the kidneys. It also promotes water conservation by reducing the urine output.

 

3.    Gonadocorticoids: Gonadocorticoids are considered to stimulate the devel­opment of male secondary sexual characteristics like hoarseness of voice, presence of body and pubic hair, etc. Androstenedione and androstenolone (dehydro-3-epiandrosterone) are gonadocorticoids produced from the adrenal cortex.

 

 

 

·        Hypoadrenalism (e.g. due to Addison's disease)

·        Cushing's syndrome

·        Congenital adrenal hyperplasia

·        Conn's syndrome

 

·        Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla.

 

Cushing's syndrome or hypercortisolism is an endocrine disorder caused by excessive levels of the endogenous corticosteroid hormone cortisol. It may also be induced iatrogenically by treatment with exogenous corticosteroids for other medical conditions. When Cushing's is suspected, a dexamethasone suppression test (administration of dexamethasone and frequent determination of cortisol and ACTH levels) and 24-hour urinary measurement for cortisol have equal detection rates. A novel approach is sampling cortisol in saliva over 24 hours, which may be equally sensitive.

 

Cortisol is secreted by the adrenal glands under regulation by the pituitary gland and hypothalamus. Strictly, Cushing's syndrome refers to excess cortisol of any etiology. Cushing's disease refers only to hypercortisolism secondary to excess production of adrenocorticotropin (ACTH) from a pituitary gland adenoma.

 

 

A pheochromocytoma is a tumor of the medulla of the adrenal glands originating in the chromaffin cells, which secretes excessive amounts of catecholamines, usually epinephrine and norepinephrine. The diagnosis can be established by measuring catecholamine and metanephrines in plasma or urine. One diagnostic test used in the past for a pheochromocytoma is to administer clonidine (Catapres®), a centrally-acting alpha-2 agonist used to treat high blood pressure.

 

 

 

The pancreas is an organ that serves two functions:

 

Exocrine - it produces pancreatic juice containing digestive enzymes.

Endocrine - it produces several important hormones, including insulin.

 

The pancreas is an organ located posterior to the stomach and in close association with the duodenum. The pancreas is a small, elongated organ in the abdomen. It is described as having a head, body and tail. The pancreatic head abuts the second part of the duodenum while the tail extends towards the spleen. The pancreatic duct runs the length of the pancreas and empties into the second part of the duodenum at the ampulla of Vater. The common bile duct commonly joins the pancreatic duct at or near this point.

 

The pancreas produces enzymes that break down all categories of digestible foods (exocrine pancreas) and secretes hormones that affect carbohydrate metabolism (endocrine pancreas).

 

The pancreas is covered in a tissue capsule that partitions the gland into lobules. The bulk of the pancreas is composed of pancreatic exocrine cells, whose ducts are arranged in clusters called acini (singular acinus). The cells are filled with secretory granules containing the pre-cursor digestive enzymes (mainly trypsinogen, chymotrypsinogen, pancreatic lipase, and amylase) that are secreted into the lumen of the acinus. These granules are termed zymogen granules (zymogen referring to the inactive precursor enzymes). Zymogen granules are localized to the subapical area of pancreatic acinar cells.

 

The pancreas is the main source of enzymes for digesting fats (lipids) and proteins - the intestinal walls have enzymes that will digest polysaccharides. The two major proteases the pancreas secretes are trypsinogen and chymotrypsinogen. Pancreatic secretions accumulate in intralobular ducts that drain to the main pancreatic duct, which drains directly into the duodenum.

 

Due to the potency of its enzyme contents, it is a very dangerous organ to injure and a puncture of the pancreas tends to require careful medical intervention.

 

Embedded throughout the exocrine tissue are small clusters of cells called the Islets of Langerhans, which are the endocrine cells of the pancreas and secrete insulin, glucagon, and several other hormones. The islets contain three major types of cells — alpha cells, beta cells, and delta cells. The largest number of cells are, by far, the beta cells which produce insulin. The alpha cells produce glucagon and the delta cells produce somatostatin, which lead to both decreased glucagon and insulin levels. There are also the PP cells and the D1 cells, about which little is known.

 

·        Benign tumors

·        Carcinoma of pancreas

·        Cystic fibrosis-Cystic fibrosis (CF), also called mucoviscidosis is an autosomal recessive hereditary disease of the exocrine glands. It affects the lungs, sweat glands and the digestive system. It causes chronic respiratory and digestive problems. About one in five babies with CF are diagnosed at birth, when their gut becomes blocked by extra thick meconium (the black tar-like bowel contents that all babies pass soon after birth). This condition may need surgery. Just over half of people with CF are diagnosed as babies because they are not growing or putting on weight as they should. This is because the pancreas is not producing chemicals (enzymes) which pass into the gut as food leaves the stomach. Without these enzymes, the fat in food cannot be properly digested. In children who are affected, the fat passes straight through the gut. The child does not benefit from the energy from the fat. Since the stools contain an excess of fat, they are oily and very smelly.

·        Diabetes

·        Acute pancreatitis

·        Chronic pancreatitis

·        Pancreatic pseudocyst-A pancreatic pseudocyst is a circumscribed collection of pancreatic fluid typically located in the lesser omentum.

 

Pancreatic cancer (also called cancer of the pancreas) is represented by the growth of a malignant tumour within the small pancreas organ.

 

1. The most common form of this disease is known as adenocarcinoma of the pancreas. It is one of the most lethal forms of cancer with few victims still alive 5 years after diagnosis, and complete remission still extremely rare.

2. A less common, and typically far less aggressive form of pancreatic cancer, is called islet-cell tumor (and is sometimes also known by the term neuroendocrine tumor).

 

 

Male gender

African-American ethnicity

Smoking

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