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                               Endocrine System

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                               Endocrine System

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The endocrine system is a network of glands and organs that produce hormones, chemical messengers that travel through the bloodstream to regulate various bodily functions. It acts like a complex communication system, coordinating many processes in the body, including growth and development, metabolism, mood, sexual function, and reproduction.

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The endocrine system is a chemical messenger system consisting of hormones, the group of glands of an organism that secrete those hormones directly into the circulatory system to regulate the function of distant target organs, and the feedback loops which modulate hormone release so that homeostasis is maintained.

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The major glands of the endocrine system include:

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The major glands of the endocrine system include:

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Pituitary gland: Often referred to as the "master gland," it produces several hormones that control other endocrine glands.

Pituitary gland: A pea-sized gland located at the base of the brain that produces several hormones that regulate various body functions.

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What conditions and disorders are related to the pituitary gland?

Several conditions can affect or are affected by your pituitary gland's function. The four main categories of issues related to your pituitary gland include:

Pituitary adenomas

A pituitary adenoma is a benign (noncancerous) growth on your pituitary gland. They make up 10% to 15% of all tumors that develop within your skull.

Pituitary adenomas are usually slow-growing, but if they grow too big, they can put pressure on nearby structures and cause symptoms. They can also compress your optic nerve and lead to vision disturbances (loss of peripheral vision). In rare cases, large pituitary adenomas can bleed internally.

Some pituitary adenomas release excess pituitary hormones. These are called functioning (secreting) adenomas. Others don't release any hormones. These are called non-functioning adenomas.

There are several different types of functioning pituitary adenomas based on which hormone they release. The most common functioning adenoma is a prolactinoma, which releases excess prolactin. Prolactinomas are typically treated with medication.

Pituitary tumors that grow too big and/or release hormones require treatment, which usually involves surgery.

Hypopituitarism

Hypopituitarism is a condition in which there's a lack of one, multiple or all of the hormones your pituitary gland makes.

Most cases of hypopituitarism involve one hormone deficiency. A deficiency in two or more of the pituitary hormones is called panhypopituitarism. This typically happens after pituitary surgery or brain radiation.

Hypopituitarism is most often caused by some type of damage to your pituitary gland or hypothalamus.

Specific conditions that involve a deficiency of a pituitary hormone include:

Growth hormone deficiency: This condition happens when your pituitary doesn't release enough growth hormone (GH). In children, it causes a lack of growth and development and delayed puberty. In adults, it causes metabolic issues.

Central diabetes insipidus: This condition happens when your pituitary doesn't release enough antidiuretic hormone (ADH, or vasopressin). This causes your body to produce too much urine (pee), and it isn't able to retain enough water.

Central hypogonadism: This condition happens when your pituitary doesn't release enough luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This causes issues with sexual function and development and fertility.

Central adrenal insufficiency: This condition happens when your pituitary doesn't release enough ACTH. It causes your body to be unable to release cortisol.

Central hypothyroidism: This condition happens when your pituitary doesn't release enough thyroid-stimulating hormone (TSH). It causes low thyroid hormone levels.

Treatment of hypopituitarism involves replacing the lacking hormones and monitoring the levels through blood tests.

Hyperpituitarism

Hyperpituitarism happens when your pituitary gland makes too much of one or more hormones. It's often caused by a functioning/secreting pituitary adenoma (a noncancerous tumor).

Specific conditions that involve an excess of a pituitary hormone include:

Acromegaly: This condition happens when your pituitary gland releases too much growth hormone as an adult. It causes enlargement of certain parts of your body, such as your hands, feet and/or organs, and metabolic issues.

Gigantism: This condition happens when your pituitary gland releases too much growth hormone as a child or adolescent. It causes rapid growth and very tall height.

Cushing's disease: This condition happens when your pituitary gland releases too much ACTH (adrenocorticotropic hormone), which causes your adrenal gland to make too much cortisol. It causes rapid weight gain in certain areas of your body and high blood sugar, which can develop into Type 2 diabetes.

Hyperprolactinemia: This condition happens when your pituitary gland releases too much prolactin. It causes infertility and milky nipple discharge (galactorrhea).

Empty sella syndrome

Empty sella syndrome (ESS) is a rare condition in which your pituitary gland becomes flattened or shrinks due to issues with the sella turcica, a bony structure at the base of your brain that surrounds and protects your pituitary gland. The sella turcica is a saddle-like compartment. In Latin, it means "Turkish seat."

Empty sella is a radiographic diagnosis. Oftentimes, it doesn't translate into a true medical condition and is often found by accident on imaging.

In some cases, ESS may cause certain symptoms, including hormone imbalances, frequent headaches and vision changes. However, if the pituitary hormone levels are within normal ranges, it's not a cause for concern.

What are the symptoms of pituitary gland problems?

Large pituitary adenomas (macroadenomas), which are benign (non-cancerous) tumors that develop on your pituitary gland, can put pressure on or damage nearby tissues. This can cause the following symptoms:

Vision problems (loss of peripheral vision).

Headaches.

Hormonal imbalances from pituitary hormone excess or deficiency.

Pituitary hormone imbalances can cause many different symptoms depending on which hormone is affected, including:

A lack of growth or excess growth in children.

Male and female infertility.

Irregular periods.

Unexplained weight gain or weight loss.

Depression and/or anxiety.

It's important to talk to your healthcare provider any time you're experiencing new, persistent symptoms. They can order some simple blood tests to see if your symptoms are related to hormone issues or something else.

What kind of healthcare provider treats pituitary gland issues?

Endocrinologists typically treat pituitary gland issues.

An endocrinologist is a healthcare provider who specializes in endocrinology, a field of medicine that studies conditions related to your hormones. An endocrinologist can diagnose endocrine (hormone) conditions, develop treatment and management plans for them and prescribe medication.

If you have a pituitary gland issue, such as a pituitary adenoma, that's affecting structures in your brain and/or requires surgery, you'll also need to see a neurosurgeon.

How do healthcare providers diagnose pituitary gland issues?

Since your pituitary gland releases hormones directly into your bloodstream, healthcare providers often rely on blood tests to measure pituitary hormone levels.

If you have irregular hormone levels, your provider may also order imaging tests, such as a CT scan or MRI scan, to evaluate your pituitary gland for any issues. Typically, providers order a dedicated pituitary MRI to see your pituitary gland and stalk more clearly.

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Pituitary Gland: What It Is, Function & Anatomy

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Your pituitary gland is a small, pea-sized endocrine gland located at the base of your brain below your hypothalamus. It releases several important hormones.

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Located in the neck, it secretes thyroid hormones that regulate metabolism and energy balance.

Thyroid gland: A butterfly-shaped gland located in the front of the neck that produces thyroid hormones.

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Overview

What is the thyroid?

Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. It's a part of your endocrine system and controls many of your body's important functions by producing and releasing (secreting) certain hormones. Your thyroid's main job is to control the speed of your metabolism (metabolic rate), which is the process of how your body transforms the food you consume into energy. All of the cells in your body need energy to function.

When your thyroid isn't working properly, it can impact your entire body.

What is the endocrine system?

Your endocrine system is a network of several glands that create and secrete (release) hormones.

A gland is an organ that makes one or more substances, such as hormones, digestive juices, sweat or tears. Endocrine glands release hormones directly into the bloodstream.

Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it.

The following organs and glands make up your endocrine system:

Function

What does my thyroid do?

As an endocrine gland, your thyroid makes and secretes hormones. Your thyroid produces and releases the following hormones:

Thyroxine (T4): This is the primary hormone your thyroid makes and releases. Although your thyroid makes the most of this hormone, it doesn't have much of an effect on your metabolism. Once your thyroid releases T4 into your bloodstream, it can convert to T3 through a process called deiodination.

Triiodothyronine (T3): Your thyroid produces lesser amounts of T3 than T4, but it has a much greater effect on your metabolism than T4.

Reverse triiodothyronine (RT3): Your thyroid makes very small amounts of RT3, which reverses the effects of T3.

Calcitonin: This hormone helps regulate the amount of calcium in your blood.

In order to make thyroid hormones, your thyroid gland needs iodine, an element found in food (most commonly, iodized table salt) and water. Your thyroid gland traps iodine and transforms it into thyroid hormones. If you have too little or too much iodine in your body, it can affect the level of hormones your thyroid makes and releases.

Your thyroid hormones affect the following bodily functions:

How your body uses energy (metabolism).

Breathing.

Digestion.

Body temperature.

Brain development.

Mental activity.

Skin and bone maintenance.

Fertility.

What other organs and glands interact with the thyroid?

Your endocrine system is an elaborate network of glands and hormones. Many glands and hormones rely on other glands and hormones to send them signals to start working. In addition, certain hormones can suppress other hormones.

Your body has a complex system for controlling the level of thyroid hormones in your body. First, your hypothalamus (a part of your brain located on the undersurface of it) secretes thyroid-releasing hormone (TRH), which stimulates a part of your pituitary gland to secrete thyroid-stimulating hormone (TSH). TSH then stimulates your thyroid follicular cells to release thyroxine (T4) and triiodothyronine (T3) if there are adequate levels of iodine in your body.

Your thyroid gland and its hormones affect almost every organ system of your body, including:

Your cardiovascular system: Your thyroid helps regulate the amount of blood your heart pumps through your circulatory system (cardiac output), heart rate and strength and vigor of your heart's contraction (contractility of the heart).

Your nervous system: When your thyroid isn't working properly, it can cause symptoms that affect your nervous system, including numbness, tingling, pain or a sense of burning in the affected parts of your body. In addition, hypothyroidism can cause depression and hyperthyroidism can cause anxiety.

Your digestive system: Your thyroid is involved with how food moves through your digestive system (gastrointestinal motility).

Your reproductive system: If your thyroid isn't working properly, it can cause irregular menstrual periods and issues with fertility.

Can a person live without a thyroid?

Yes, you can live without your thyroid. However, you'll need to take hormone replacement medication for the rest of your life in order to stay healthy and prevent certain side effects and symptoms. Thyroid removal surgery, known as a thyroidectomy, is a common surgery that can treat certain thyroid conditions.

Anatomy

Where is the thyroid located?

Your thyroid gland is located in the front of your neck, straddling your windpipe (trachea). It's shaped like a butterfly - smaller in the middle with two wide wings that extend around the side of your throat. A healthy thyroid gland is not usually visible from the outside (there's no appearance of a lump on your neck), and you can't feel it when you press your finger to the front of your neck.

What are the parts of the thyroid?

There are two main parts of your thyroid: the two halves (lobes) and the middle of the thyroid that connects the two lobes (thyroid isthmus).

Your thyroid is made of thyroid follicle cells (thyrocytes), which create and store thyroid hormone (mainly T3 and T4), and C-cells, which secrete the hormone calcitonin.

How big is the thyroid?

Your thyroid is about 2 inches long. A healthy thyroid usually does not stick out from your throat and you can't see it by looking at your neck.

However, certain conditions can cause your thyroid to become enlarged. This is known as goiter. If you have a goiter, you may experience the following symptoms:

Swelling in the front of your neck, just below the Adam's apple.

A feeling of tightness in your throat area.

A change in your voice, such as hoarseness (scratchy voice).

Conditions and Disorders

What conditions and disorders affect the thyroid?

There are several different types of thyroid disease. Thyroid disease is very common, with an estimated 20 million people in the United States having some type of thyroid disorder. Women and people assigned female at birth (AFAB) are about five to eight times more likely to be diagnosed with a thyroid condition than men and people assigned male at birth (AMAB).

Thyroid diseases are split into two types: primary and secondary.

In primary thyroid disease, the disease originates in your thyroid gland. In secondary thyroid disease, the disease originates in your pituitary gland. As an example, if you have a nodule on your thyroid that's releasing excess amounts of thyroid hormones, it would be called primary hyperthyroidism. If a tumor in your pituitary gland is releasing excess amounts of thyroid-stimulating hormone (TSH), which then stimulates your thyroid to produce excess thyroid hormones, it would be called secondary hyperthyroidism.

The four main conditions that affect your thyroid include:

Hypothyroidism

Hypothyroidism (underactive thyroid) happens when your thyroid doesn't produce and release enough thyroid hormones. This causes aspects of your metabolism to slow down. It's a fairly common condition that affects approximately 10 million people in the United States. It is treatable.

Causes of hypothyroidism include:

Hashimoto's disease, an autoimmune disease.

Thyroiditis (inflammation of the thyroid).

Iodine deficiency.

A nonfunctioning thyroid gland (when the thyroid doesn't work correctly from birth).

Over-treatment of hyperthyroidism through medication.

Thyroid gland removal.

Hyperthyroidism

Hyperthyroidism (overactive thyroid) happens when your thyroid produces and releases more thyroid hormones than your body needs. This causes aspects of your metabolism to speed up. Approximately 1 out of 100 people over the age of 12 have hyperthyroidism in the United States. It is treatable.

Causes of hyperthyroidism include:

Graves' disease, an autoimmune condition.

Thyroid nodules.

Thyroiditis (inflammation of the thyroid).

Postpartum thyroiditis (inflammation of the thyroid that happens after giving birth).

Excess iodine in your blood from diet and/or medication.

Over-treatment of hypothyroidism through medication.

A benign (noncancerous) tumor in your pituitary gland.

Goiter

Goiter is an enlargement of your thyroid gland. Goiters are relatively common; they affect approximately 5% of people in the United States

Goiters have different causes, depending on their type.

Simple goiters: These goiters develop when your thyroid gland doesn't make enough hormones to meet your body's needs. Your thyroid gland tries to make up for the shortage by growing larger.

Endemic goiters: These goiters occur in people who don't get enough iodine in their diet (iodine is necessary to make thyroid hormone). Iodine is added to table salt in the United States and several other countries, so people who live in those countries usually don't get endemic goiters.

Sporadic goiters: These goiters have no known cause in most cases. In some cases, certain medications, such as lithium, can cause sporadic goiters.

Thyroid cancer

Thyroid cancer is cancer that begins in your thyroid tissues. Approximately 53,000 people in the United States receive a diagnosis of thyroid cancer every year. Treatments for most thyroid cancers are very successful.

Thyroid cancer is classified based on the type of cells from which cancer grows. Thyroid cancer types include:

Papillary: Up to 80% of all thyroid cancer cases are papillary.

Follicular: Follicular thyroid cancer accounts for up to 15% of thyroid cancer diagnoses.

Medullary: About 2% of thyroid cancer cases are medullary. It's often caused by a gene mutation.

Anaplastic: About 2% of thyroid cancer cases are anaplastic.

What are the early warning signs and symptoms of thyroid problems?

Different thyroid conditions have different symptoms. However, since your thyroid has a large role in certain body systems and processes, such as heart rate, metabolism and temperature control, there are certain symptoms to look out for that could be a sign of a thyroid condition, including:

Slow or rapid heart rate.

Unexplained weight loss or weight gain.

Difficulty tolerating cold or heat.

Depression or anxiety.

Irregular menstrual periods.

If you're experiencing any of these symptoms, talk to your healthcare provider about getting a blood test to check your thyroid function.

What are common tests to check the health of the thyroid?

The first-line test for checking the health of your thyroid is a blood test that measures your levels of thyroid-stimulating hormone (TSH). It's a screening test for both hypothyroidism and hyperthyroidism.

In general, the normal range for a TSH blood test is 0.5 to 5.0 mIU/L (milli-international units per liter). However, this can vary from lab to lab and depending on certain factors, such as pregnancy and your age.

Your provider can also check the levels of T4 and T3 (thyroid hormones) in your blood.

If your test results come back abnormal your provider may suggest having an imaging test such as a thyroid scan, which uses small amounts of a safe, radioactive material to create images of your thyroid, or a thyroid ultrasound.

How are thyroid conditions treated?

There are several treatment options for thyroid conditions depending on what the conditions are and how severe they are. The three main options for treatment include:

Medication

Medications for thyroid conditions include:

Antithyroid medications: These medications block the ability of your thyroid to make hormones. Healthcare providers may prescribe this for hyperthyroidism.

Beta-blockers: These medications help treat symptoms of hyperthyroidism, such as rapid heartbeat, but they do not treat the thyroid condition itself.

Radioactive iodine: This medication damages thyroid cells, eventually leading to the destruction of your thyroid gland. This is a treatment option for hyperthyroidism and thyroid cancer.

Thyroid hormone medications: These medications are a synthetic form of thyroid hormones for the treatment of hypothyroidism. People who have a thyroidectomy or a nonfunctioning thyroid from radioactive iodine usually need to take these medications for the rest of their life.

Surgery

The most common type of surgery associated with thyroid conditions is a thyroidectomy. A thyroidectomy is the surgical removal of your entire thyroid gland. Thyroidectomy is one of the treatment options for thyroid disease and is the first-line treatment for thyroid cancer.

Another surgery option is a lobectomy, which involves removing only a part of your thyroid.

Radiation therapy and chemotherapy

Radiation therapy and/or chemotherapy are treatment options for thyroid cancer. Both therapies kill cancer cells and prevent them from growing. Most cases of thyroid cancer do not require radiation or chemotherapy.

What are the risk factors for developing a thyroid condition?

Thyroid conditions are common and can affect anyone at any age. However, some factors put you at a higher risk of developing a thyroid condition, including:

Being older than 60, especially if you're a woman or a person who was assigned female at birth (AFAB).

Care

How can I keep my thyroid healthy?

The main way to keep your thyroid healthy is to make sure you're getting enough iodine in your diet. Your thyroid needs iodine to make thyroid hormones. The good news is that the majority of people get adequate amounts of iodine through iodized table salt and foods that are fortified with iodine.

Other food sources that contain iodine include:

However, it's important not to consume too much iodine because it can cause problems. If you have any questions or concerns about your thyroid health, don't be afraid to talk to your healthcare provider.

When should I call my doctor about my thyroid?

If you're experiencing symptoms of thyroid disease, such as changes in your weight, heart rate and temperature sensitivity, contact your healthcare provider. They can run a simple blood test to see if your thyroid is the cause of your symptoms.
A note from Cleveland Clinic
Your thyroid is an important gland in your endocrine system that affects many aspects of your body. Thyroid disease is very common and treatable. If you experience any thyroid disease-related symptoms or want to know if you have any risk factors for developing thyroid disease, don't be afraid to talk to your healthcare provider. They're there to help you.

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Thyroid: What It Is, Function & Problems

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Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. It's a part of your endocrine system and controls many of your body's important functions by producing and releasing (secreting) certain hormones.

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Situated behind the thyroid gland, they produce parathyroid hormone (PTH), which helps regulate calcium levels in the blood. Four tiny glands located behind the thyroid gland that produce parathyroid hormone (PTH).

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National Institute of Diabetes and Digestive and Kidney Diseases

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What is primary hyperparathyroidism?

Primary hyperparathyroidism is a disorder of the parathyroid glands, four pea-sized glands located on or near the thyroid gland in the neck. "Primary" means this disorder begins in the parathyroid glands, rather than resulting from another health problem such as kidney failure. In primary hyperparathyroidism, one or more of the parathyroid glands is overactive. As a result, the gland makes too much parathyroid hormone (PTH).

Too much PTH causes calcium levels in your blood to rise too high, which can lead to health problems such as bone thinning and kidney stones. Doctors usually catch primary hyperparathyroidism early through routine blood tests, before serious problems occur.

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What do the parathyroid glands do?

The parathyroid glands' only purpose is to make PTH, which helps maintain the right balance of calcium in your body. PTH raises blood calcium levels by

causing bone, where most of your body's calcium is stored, to release calcium into the blood

helping your intestines absorb calcium from food

helping your kidneys hold on to calcium and return it to your blood instead of flushing it out in urine

When the level of calcium in your blood falls too low, the parathyroid glands release just enough PTH to bring your blood calcium levels back to normal.

You need calcium for good health. This mineral helps build bones and teeth and keep them strong. Calcium also helps your heart, muscles, and nerves work normally.

Although their names are similar, the parathyroid glands and the thyroid gland are not related.

How common is primary hyperparathyroidism?

In the United States, about 100,000 people develop primary hyperparathyroidism each year. ¹ Primary hyperparathyroidism is one of the most common hormonal disorders.

Who is more likely to develop primary hyperparathyroidism?

Primary hyperparathyroidism most often affects people between age 50 and 60. Women are affected 3 to 4 times more often than men. ¹ The disorder was more common in African Americans, followed by Caucasians, in one large study performed in North America. ¹

What are the complications of primary hyperparathyroidism?

Primary hyperparathyroidism most often affects the bones and kidneys, although it also may play a part in other health problems.

Weakened bones

High PTH levels trigger the bones to release more calcium than normal into the blood. The loss of calcium from the bones may weaken them.

Kidney stones

The small intestine may absorb more calcium from food, adding to high levels of calcium in your blood. Extra calcium that isn't used by your bones and muscles goes to your kidneys and is flushed out in urine. Too much calcium in your urine can cause kidney stones.

Other complications

High blood calcium levels might play a part in other problems, such as heart disease, high blood pressure, and trouble concentrating. However, more research is needed to better understand how primary hyperparathyroidism affects the heart, blood vessels, and brain.

What are the symptoms of primary hyperparathyroidism?

Most people with primary hyperparathyroidism have no symptoms. When symptoms appear, they're often mild and similar to those of many other disorders. Symptoms include

muscle weakness

fatigue

depression

aches and pains in bones and joints

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People with more severe disease may have

What causes primary hyperparathyroidism?

In about 8 out of 10 people with primary hyperparathyroidism, a benign, or noncancerous, tumor called an adenoma has formed in one of the parathyroid glands. ² The tumor causes the gland to become overactive. In most other cases, extra PTH comes from two or more adenomas or from hyperplasia, a condition in which all four parathyroid glands are enlarged. People with rare inherited conditions that affect the parathyroid glands, such as multiple endocrine neoplasia type 1 or familial hypocalciuric hypercalcemia, are more likely to have more than one gland affected.

Rarely, primary hyperparathyroidism is caused by cancer of a parathyroid gland.

How do doctors diagnose primary hyperparathyroidism?

Doctors diagnose primary hyperparathyroidism when a blood test shows high blood calcium and PTH levels. Sometimes PTH levels are in the upper portion of the normal range, when they should drop to low-normal or below normal in response to high calcium levels. Other conditions can cause high calcium, but elevated PTH is the only source in primary hyperparathyroidism.

Routine blood tests can detect high blood calcium levels. High blood calcium may cause health care professionals to suspect hyperparathyroidism, even before symptoms appear.

Sometimes PTH levels are high but calcium levels are not. Doctors don't routinely test for PTH but may do so if you have osteoporosis or another disorder that affects bone strength. In some cases, this may be the first phase of primary hyperparathyroidism, before calcium levels start to rise.

Once doctors diagnose hyperparathyroidism, a 24-hour urine collection can help find the cause. This test measures certain chemicals, such as calcium and creatinine, a waste product that healthy kidneys remove. You will collect your urine over a 24-hour period and your health care professional will send it to a lab for analysis. Results of the test may help tell primary hyperparathyroidism from hyperparathyroidism caused by a kidney disorder. The test can also rule out familial hypocalciuric hypercalcemia, a rare genetic disorder, as a cause.

What tests do doctors use to look for complications of primary hyperparathyroidism?

Once doctors diagnose primary hyperparathyroidism, they may use other tests to look for bone weakness, kidney problems, and low levels of vitamin D.

Bone mineral density test

Dual energy x-ray absorptiometry, also called a DXA or DEXA scan, uses low-dose x-rays to measure bone density. During the test, you will lie on a padded table while a technician moves the scanner over your body. A bone expert or radiologist will read the scan.

Kidney imaging tests

Doctors may use one of the following imaging tests to look for kidney stones.

Ultrasound. Ultrasound uses a device called a transducer that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician does the procedure. A radiologist reads the images, which can show kidney stones.

Abdominal x-ray. An abdominal x-ray is a picture of the abdomen that uses low levels of radiation and is recorded on film or on a computer. During an abdominal x-ray, you lie on a table or stand up. A technician positions the x-ray machine close to your abdomen and asks you to hold your breath so the picture won't be blurry. A radiologist reads the x-ray, which can show the location of kidney stones in the urinary tract. Not all stones are visible on an abdominal x-ray.

Computed tomography (CT) scans. CT scans use a combination of x-rays and computer technology to create images of your urinary tract. CT scans sometimes use a contrast medium-a dye or other substance that makes structures inside your body easier to see. Contrast medium isn't usually needed to see kidney stones. For the scan, you'll lie on a table that slides into a tunnel-shaped machine that takes the x-rays. A radiologist reads the images, which can show the size and location of a kidney stone.

Vitamin D blood test

Health care professionals test for vitamin D levels because low levels are common in people with primary hyperparathyroidism. In patients with primary hyperparathyroidism, the low vitamin D level can further stimulate the parathyroid glands to make even more parathyroid hormone. Also, a very low vitamin D level may cause a secondary form of hyperparathyroidism, which resolves when vitamin D levels are returned to normal.

How do doctors treat primary hyperparathyroidism?

Guidelines help doctors to decide whether or not parathyroid surgery should be recommended. You might be a candidate for surgery if you meet any of these guidelines

1. Blood calcium > 1 mg/dL above normal

2. Bone density by DXA < -2.5 at any site (lumbar spine, hip, or forearm)

3. History of kidney stones or evidence of kidney stones or calcifications in the kidney by imaging (e.g., X-ray, ultrasound, CT scan). Evidence for stone risk by 24-hour urine with excessive calcium and other stone risk factors.

4. A fracture resulting from relatively little force, such as a fall from a standing or sitting position (a fragility fracture)

5. Age < 50

Doctors most often recommend parathyroid surgery, particularly if the patient meets one or more of the guidelines noted above. It is also not inappropriate to recommend surgery in those who do not meet guidelines as long as there are no medical contraindications to surgery. In those who do not meet guidelines or do not choose surgery, the doctor will monitor the patient's condition. If there is evidence for progressive disease (e.g., higher calcium level, lower bone density, a fracture, kidney stone), surgery would be advised. For patients who are not going to have parathyroid surgery, even though guidelines are met, doctors can prescribe medicines to control the high blood calcium or improve the bone density.

Surgery

Surgery to remove the overactive parathyroid gland or glands is the only sure way to cure primary hyperparathyroidism. Doctors recommend surgery for people with clear symptoms or complications of the disease. In people without symptoms, doctors follow the above guidelines to identify who might benefit from parathyroid surgery. ² Surgery can lead to improved bone density and can lower the chance of forming kidney stones.

When performed by experienced surgeons, surgery almost always cures primary hyperparathyroidism.

Surgeons often use imaging tests before surgery to locate the overactive gland or glands to be removed. The tests used most often are sestamibi, ultrasound, and CT scans. In a sestamibi scan, you will get an injection, or shot, of a small amount of radioactive dye in your vein. The overactive parathyroid gland or glands then absorb the dye. The surgeon can see where the dye has been absorbed by using a special camera.

Surgeons use two main types of operations to remove the overactive gland or glands.

Minimally invasive parathyroidectomy. Also called focused parathyroidectomy, surgeons use this type of surgery when they think only one of the parathyroid glands is overactive. Guided by a tumor-imaging test, your surgeon will make a small incision, or cut, in your neck to remove the gland. The small incision means you will probably have less pain and a faster recovery than people who have more invasive surgery. You can go home the same day. Your doctor may use regional or general anesthesia during the surgery.

Bilateral neck exploration. This type of surgery uses a larger incision that lets the surgeon find and look at all four parathyroid glands and remove the overactive ones. If you have bilateral neck exploration, you will probably have general anesthesia and may need to stay in the hospital overnight.

Parathyroid surgery is safe. Rarely, problems can occur after surgery. In about 1 out of every 100 people, the nerves controlling the vocal cords are damaged during surgery, which most often results in hoarseness. ³ This condition usually gets better on its own.

Low calcium levels in the blood may occur after surgery but usually return to normal in a few days or weeks. On rare occasions, not enough parathyroid tissue is left to make PTH, which can result in hypoparathyroidism.

Monitoring

Some people who have mild primary hyperparathyroidism may not need surgery right away, or even any surgery, and can be safely monitored.

You may want to talk with your doctor about long-term monitoring if you

don't have symptoms

have only slightly high blood calcium levels

have normal kidneys and bone density

Long-term monitoring should include regular doctor visits, a yearly blood test to measure calcium levels and check your kidney function, and a bone density test every 1 to 2 years.

If you and your doctor choose long-term monitoring, you should

Medicines

Cinacalcet is a medicine that decreases the amount of PTH the parathyroid glands make and lowers calcium levels in the blood. Doctors may prescribe cinacalcet to treat very high calcium levels in people with primary hyperparathyroidism who can't have surgery.

Cinacalcet does not improve bone density. If you have bone loss, your doctor may prescribe alendronate or other medications to help increase bone density.

Should I change my diet if I have primary hyperparathyroidism?

You don't need to change your diet or limit the amount of calcium you get from food and beverages. You will need to take a vitamin D supplement if your vitamin D levels are low. Talk with your health care professional about how much vitamin D you should take.

If you lose all your healthy parathyroid tissue and develop lasting low-calcium levels, you'll need to take both calcium and vitamin D for life.

References

[1] Bilezikian JP. Primary hyperparathyroidism. In: De Groot LJ, Chrousos G, Dungan K, et al., eds. Diseases of Bone and Mineral Metabolism. South Dartmouth, MA: MDTEXT.COM, Inc. 2000-2018. https://www.ncbi.nlm.nih.gov/books/NBK278923/. Updated January 15, 2017. Accessed June 6, 2018.

[2] Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. The Journal of Clinical Endocrinology and Metabolism. 2014;99(10):3561-3569.

[3] Callender GG, Udelsman R. Surgery for primary hyperparathyroidism. Cancer. 2014;120(23):3602-3616.

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Primary hyperparathyroidism is a disorder of the parathyroid glands, four pea-sized glands located on or near the thyroid gland in the neck. "Primary" means this disorder begins in the parathyroid glands, rather than resulting from another health problem such as kidney failure. In primary hyperparathyroidism, one or more of the parathyroid glands is overactive.

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Located on top of the kidneys, they produce several hormones, including cortisol (stress hormone) and adrenaline (epinephrine). Two triangular glands located on top of the kidneys that produce several hormones, including cortisol and adrenaline.

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Located behind the stomach, it produces insulin and glucagon, essential hormones for regulating blood sugar levels. A gland located behind the stomach that produces digestive enzymes and hormones, including insulin and glucagon.

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The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e., it has both an endocrine and a digestive exocrine function. 99% of the pancreas is exocrine and 1% is endocrine. As an endocrine gland, it functions mostly to regulate blood sugar levels, secreting the hormones insulin, glucagon, somatostatin and pancreatic polypeptide. As a part of the digestive system, it functions as an exocrine gland secreting pancreatic juice into the duodenum through the pancreatic duct. This juice contains bicarbonate, which neutralizes acid entering the duodenum from the stomach; and digestive enzymes, which break down carbohydrates, proteins and fats in food entering the duodenum from the stomach.

Inflammation of the pancreas is known as pancreatitis, with common causes including chronic alcohol use and gallstones. Because of its role in the regulation of blood sugar, the pancreas is also a key organ in diabetes mellitus. Pancreatic cancer can arise following chronic pancreatitis or due to other reasons, and carries a very poor prognosis, as it is often only identified after it has spread to other areas of the body.

The word pancreas comes from the Greek πᾶν (pân, "all") & κρέας (kréas, "flesh"). The function of the pancreas in diabetes has been known since at least 1889, with its role in insulin production identified in 1921.

The pancreas (shown here in pink) sits behind the stomach, with the body near the curvature of the duodenum, and the tail stretching to touch the spleen.

The pancreas is an organ that in humans lies in the abdomen, stretching from behind the stomach to the left upper abdomen near the spleen. In adults, it is about 12-15 centimetres (4.7-5.9 in) long, , and salmon-coloured in appearance.

Anatomically, the pancreas is divided into a head, neck, body, and tail. The pancreas stretches from the inner curvature of the duodenum, where the head surrounds two blood vessels: the superior mesenteric artery and vein. The longest part of the pancreas, the body, stretches across behind the stomach, and the tail of the pancreas ends adjacent to the spleen.

Two ducts, the main pancreatic duct and a smaller accessory pancreatic duct run through the body of the pancreas. The main pancreatic duct joins with the common bile duct forming a small ballooning called the ampulla of Vater (hepatopancreatic ampulla). This ampulla is surrounded by a muscle, the sphincter of Oddi. This ampulla opens into the descending part of the duodenum. The opening of the common bile duct into main pancreatic duct is controlled by sphincter of Boyden. The accessory pancreatic duct opens into duodenum with separate openings located above the opening of the main pancreatic duct.

The head of the pancreas sits within the curvature of the duodenum, and wraps around the superior mesenteric artery and vein. To the right sits the descending part of the duodenum, and between these travel the superior and inferior pancreaticoduodenal arteries. Behind rests the inferior vena cava, and the common bile duct. In front sits the peritoneal membrane and the transverse colon. A small uncinate process emerges from below the head, situated behind the superior mesenteric vein and sometimes artery.

The neck of the pancreas separates the head of the pancreas, located in the curvature of the duodenum, from the body. The neck is about 2 cm (0.79 in) wide, and sits in front of where the portal vein is formed. The neck lies mostly behind the pylorus of the stomach, and is covered with peritoneum. The anterior superior pancreaticoduodenal artery travels in front of the neck of the pancreas.

The body is the largest part of the pancreas, and mostly lies behind the stomach, tapering along its length. The peritoneum sits on top of the body of the pancreas, and the transverse colon in front of the peritoneum. Behind the pancreas are several blood vessels, including the aorta, the splenic vein, and the left renal vein, as well as the beginning of the superior mesenteric artery. Below the body of the pancreas sits some of the small intestine, specifically the last part of the duodenum and the jejunum to which it connects, as well as the suspensory ligament of the duodenum which falls between these two. In front of the pancreas sits the transverse colon.

The pancreas narrows towards the tail, which sits near to the spleen. It is usually between 1.3-3.5 cm (0.51-1.38 in) long, and sits between the layers of the ligament between the spleen and the left kidney. The splenic artery and vein, which also passes behind the body of the pancreas, pass behind the tail of the pancreas.

The pancreas has a rich blood supply, with vessels originating as branches of both the coeliac artery and superior mesenteric artery. The splenic artery runs along the top of the pancreas, and supplies the left part of the body and the tail of the pancreas through its pancreatic branches, the largest of which is called the greater pancreatic artery. The superior and inferior pancreaticoduodenal arteries run along the back and front surfaces of the head of the pancreas adjacent to the duodenum. These supply the head of the pancreas. These vessels join together (anastamose) in the middle.

The body and neck of the pancreas drain into the splenic vein, which sits behind the pancreas. The head drains into, and wraps around, the superior mesenteric and portal veins, via the pancreaticoduodenal veins.

The pancreas drains into lymphatic vessels that travel alongside its arteries, and has a rich lymphatic supply. The lymphatic vessels of the body and tail drain into splenic lymph nodes, and eventually into lymph nodes that lie in front of the aorta, between the coeliac and superior mesenteric arteries. The lymphatic vessels of the head and neck drain into intermediate lymphatic vessels around the pancreaticoduodenal, mesenteric and hepatic arteries, and from there into the lymph nodes that lie in front of the aorta.

This image shows a pancreatic islet when pancreatic tissue is stained and viewed under a microscope. Parts of the digestive ("exocrine") pancreas can be seen around the islet, more darkly. These contain hazy dark purple granules of inactive digestive enzymes (zymogens).

A pancreatic islet that uses fluorescent antibodies to show the location of different cell types in the pancreatic islet. Antibodies against glucagon, secreted by alpha cells, show their peripheral position. Antibodies against insulin, secreted by beta cells, show the more widespread and central position that these cells tend to have.

The pancreas contains tissue with an endocrine and exocrine role, and this division is also visible when the pancreas is viewed under a microscope.

The majority of pancreatic tissue has a digestive role. The cells with this role form clusters ( Latin: acini) around small ducts, and are arranged in lobes that have thin fibrous walls. The cells of each acinus secrete inactive digestive enzymes called zymogens into the small intercalated ducts which they surround. In each acinus, the cells are pyramid-shaped and situated around the intercalated ducts, with the nuclei resting on the basement membrane, a large endoplasmic reticulum, and a number of zymogen granules visible within the cytoplasm. The intercalated ducts drain into larger intralobular ducts within the lobule, and finally interlobular ducts. The ducts are lined by a single layer of column-shaped cells. There is more than one layer of cells as the diameter of the ducts increases.

The tissues with an endocrine role within the pancreas exist as clusters of cells called pancreatic islets (also called islets of Langerhans) that are distributed throughout the pancreas. Pancreatic islets contain alpha cells, beta cells, and delta cells, each of which releases a different hormone. These cells have characteristic positions, with alpha cells (secreting glucagon) tending to be situated around the periphery of the islet, and beta cells (secreting insulin) more numerous and found throughout the islet. Enterochromaffin cells are also scattered throughout the islets. Islets are composed of up to 3,000 secretory cells, and contain several small arterioles to receive blood, and venules that allow the hormones secreted by the cells to enter the systemic circulation.

The size of the pancreas varies considerably. Several anatomical variations exist, relating to the embryological development of the two pancreatic buds. The pancreas develops from these buds on either side of the duodenum. The ventral bud rotates to lie next to the dorsal bud, eventually fusing. In about 10% of adults, an accessory pancreatic duct may be present if the main duct of the dorsal bud of the pancreas does not regress; this duct opens into the minor duodenal papilla. If the two buds themselves, each having a duct, do not fuse, a pancreas may exist with two separate ducts, a condition known as a pancreas divisum. This condition has no physiologic consequence. If the ventral bud does not fully rotate, an annular pancreas may exist, where part or all of the duodenum is encircled by the pancreas. This may be associated with duodenal atresia.

10,000 protein coding genes (~50% of all human genes) are expressed in the normal human pancreas. Less than 100 of these genes are specifically expressed in the pancreas. Similar to the salivary glands, most pancreas-specific genes encode for secreted proteins. Corresponding pancreas-specific proteins are either expressed in the exocrine cellular compartment and have functions related to digestion or food uptake such as digestive chymotrypsinogen enzymes and pancreatic lipase PNLIP, or are expressed in the various cells of the endocrine pancreatic islets and have functions related to secreted hormones such as insulin, glucagon, somatostatin and pancreatic polypeptide.

The pancreas originates from the foregut, a precursor tube to part of the digestive tract, as a dorsal and ventral bud. As it develops, the ventral bud rotates to the other side and the two buds fuse together.

The pancreas forms during development from two buds that arise from the duodenal part of the foregut, an embryonic tube that is a precursor to the gastrointestinal tract. It is of endodermal origin. Pancreatic development begins with the formation of a dorsal and ventral pancreatic bud. Each joins with the foregut through a duct. The dorsal pancreatic bud forms the neck, body, and tail of the developed pancreas, and the ventral pancreatic bud forms the head and uncinate process.

The definitive pancreas results from rotation of the ventral bud and the fusion of the two buds. During development, the duodenum rotates to the right, and the ventral bud rotates with it, moving to a position that becomes more dorsal. Upon reaching its final destination, the ventral pancreatic bud is below the larger dorsal bud, and eventually fuses with it. At this point of fusion, the main ducts of the ventral and dorsal pancreatic buds fuse, forming the main pancreatic duct. Usually, the duct of the dorsal bud regresses, leaving the main pancreatic duct.

Pancreatic progenitor cells are precursor cells that differentiate into the functional pancreatic cells, including exocrine acinar cells, endocrine islet cells, and ductal cells. These progenitor cells are characterised by the co-expression of the transcription factors PDX1 and NKX6-1.

The cells of the exocrine pancreas differentiate through molecules that induce differentiation including follistatin, fibroblast growth factors, and activation of the Notch receptor system. Development of the exocrine acini progresses through three successive stages. These are the predifferentiated, protodifferentiated, and differentiated stages, which correspond to undetectable, low, and high levels of digestive enzyme activity, respectively.

Pancreatic progenitor cells differentiate into endocrine islet cells under the influence of neurogenin-3 and ISL1, but only in the absence of notch receptor signaling. Under the direction of a Pax gene, the endocrine precursor cells differentiate to form alpha and gamma cells. Under the direction of Pax-6, the endocrine precursor cells differentiate to form beta and delta cells. The pancreatic islets form as the endocrine cells migrate from the duct system to form small clusters around capillaries. This occurs around the third month of development, and insulin and glucagon can be detected in the human fetal circulation by the fourth or fifth month of development.

The pancreas is involved in blood sugar control and metabolism within the body, and also in the secretion of substances (collectively pancreatic juice) that help digestion. These are divided into an "endocrine" role, relating to the secretion of insulin and other substances within pancreatic islets that help control blood sugar levels and metabolism within the body, and an "exocrine" role, relating to the secretion of enzymes involved in digesting substances in the digestive tract.

The pancreas maintains constant blood glucose levels (shown as the waving line). When the blood glucose level is too high, the pancreas secretes insulin and when the level is too low, the pancreas secretes glucagon.

Cells within the pancreas help to maintain blood glucose levels ( homeostasis). The cells that do this are located within the pancreatic islets that are present throughout the pancreas. When blood glucose levels are low, alpha cells secrete glucagon, which increases blood glucose levels. When blood glucose levels are high beta cells secrete insulin to decrease glucose in blood. Delta cells in the islet also secrete somatostatin which decreases the release of insulin and glucagon.

Glucagon acts to increase glucose levels by promoting the creation of glucose and the breakdown of glycogen to glucose in the liver. It also decreases the uptake of glucose in fat and muscle. Glucagon release is stimulated by low blood glucose or insulin levels, and during exercise. Insulin acts to decrease blood glucose levels by facilitating uptake by cells (particularly skeletal muscle), and promoting its use in the creation of proteins, fats and carbohydrates. Insulin is initially created as a precursor form called preproinsulin. This is converted to proinsulin and cleaved by C-peptide to insulin which is then stored in granules in beta cells. Glucose is taken into the beta cells and degraded. The end effect of this is to cause depolarisation of the cell membrane which stimulates the release of the insulin.

The main factor influencing the secretion of insulin and glucagon are the levels of glucose in blood plasma. Low blood sugar stimulates glucagon release, and high blood sugar stimulates insulin release. Other factors also influence the secretion of these hormones. Some amino acids, that are byproducts of the digestion of protein, stimulate insulin and glucagon release. Somatostatin acts as an inhibitor of both insulin and glucagon. The autonomic nervous system also plays a role. Activation of Beta-2 receptors of the sympathetic nervous system by catecholamines secreted from sympathetic nerves stimulates secretion of insulin and glucagon, whereas activation of Alpha-1 receptors inhibits secretion. M3 receptors of the parasympathetic nervous system act when stimulated by the right vagus nerve to stimulate release of insulin from beta cells.

The pancreas has a role in digestion, highlighted here. Ducts in the pancreas (green) conduct digestive enzymes into the duodenum. This image also shows a pancreatic islet, part of the endocrine pancreas, which contains cells responsible for secretion of insulin and glucagon.

The pancreas plays a vital role in the digestive system. It does this by secreting a fluid that contains digestive enzymes into the duodenum, the first part of the small intestine that receives food from the stomach. These enzymes help to break down carbohydrates, proteins and lipids (fats). This role is called the "exocrine" role of the pancreas. The cells that do this are arranged in clusters called . Secretions into the middle of the acinus accumulate in intralobular ducts, which drain to the main pancreatic duct, which drains directly into the duodenum. About 1.5 - 3 liters of fluid are secreted in this manner every day.

The cells in each acinus are filled with granules containing the digestive enzymes. These are secreted in an inactive form termed zymogens or proenzymes. When released into the duodenum, they are activated by the enzyme enterokinase present in the lining of the duodenum. The proenzymes are cleaved, creating a cascade of activating enzymes.

These enzymes are secreted in a fluid rich in bicarbonate. Bicarbonate helps maintain an alkaline pH for the fluid, a pH in which most of the enzymes act most efficiently, and also helps to neutralise the stomach acids that enter the duodenum. Secretion is influenced by hormones including secretin, cholecystokinin, and VIP, as well as acetylcholine stimulation from the vagus nerve. Secretin is released from the S cells which form part of the lining of the duodenum in response to stimulation by gastric acid. Along with VIP, it increases the secretion of enzymes and bicarbonate. Cholecystokinin is released from Ito cells of the lining of the duodenum and jejunum mostly in response to long chain fatty acids, and increases the effects of secretin. At a cellular level, bicarbonate is secreted from centroacinar and ductal cells through a sodium and bicarbonate cotransporter that acts because of membrane depolarisation caused by the cystic fibrosis transmembrane conductance regulator. Secretin and VIP act to increase the opening of the cystic fibrosis transmembrane conductance regulator, which leads to more membrane depolarisation and more secretion of bicarbonate.

A variety of mechanisms act to ensure that the digestive action of the pancreas does not act to digest pancreatic tissue itself. These include the secretion of inactive enzymes (zymogens), the secretion of the protective enzyme trypsin inhibitor, which inactivates trypsin, the changes in pH that occur with bicarbonate secretion that stimulate digestion only when the pancreas is stimulated, and the fact that the low calcium within cells causes inactivation of trypsin.

The pancreas also secretes vasoactive intestinal peptide and pancreatic polypeptide. Enterochromaffin cells of the pancreas secrete the hormones motilin, serotonin, and substance P.

Inflammation of the pancreas is known as pancreatitis. Pancreatitis is most often associated with recurrent gallstones or chronic alcohol use, with other common causes including traumatic damage, damage following an ERCP, some medications, infections such as mumps and very high blood triglyceride levels. Acute pancreatitis is likely to cause intense pain in the central abdomen, that often radiates to the back, and may be associated with nausea or vomiting. Severe pancreatitis may lead to bleeding or perforation of the pancreas resulting in shock or a systemic inflammatory response syndrome, bruising of the flanks or the region around the belly button. These severe complications are often managed in an intensive care unit.

In pancreatitis, enzymes of the exocrine pancreas damage the structure and tissue of the pancreas. Detection of some of these enzymes, such as amylase and lipase in the blood, along with symptoms and findings on medical imaging such as ultrasound or a CT scan, are often used to indicate that a person has pancreatitis. Pancreatitis is often managed medically with pain reliefs, and monitoring to prevent or manage shock, and management of any identified underlying causes. This may include removal of gallstones, lowering of blood triglyceride or glucose levels, the use of corticosteroids for autoimmune pancreatitis, and the cessation of any medication triggers.

Chronic pancreatitis refers to the development of pancreatitis over time. It shares many similar causes, with the most common being chronic alcohol use, with other causes including recurrent acute episodes and cystic fibrosis. Abdominal pain, characteristically relieved by sitting forward or drinking alcohol, is the most common symptom. When the digestive function of the pancreas is severely affected, this may lead to problems with fat digestion and the development of steatorrhoea; when the endocrine function is affected, this may lead to diabetes. Chronic pancreatitis is investigated in a similar way to acute pancreatitis. In addition to management of pain and nausea, and management of any identified causes (which may include alcohol cessation), because of the digestive role of the pancreas, enzyme replacement may be needed to prevent malabsorption.

Pancreatic cancer, shown here, most commonly occurs as an adenocarcinoma in the head of the pancreas. Because symptoms (such as skin yellowing, pain, or itch) do not occur until later in the disease, it often presents at a later stage and has limited treatment options.

Relative incidences of various pancreatic neoplasms, with pancreatic cancers in red/pink color.[26]

Pancreatic cancers, particularly the most common type, pancreatic adenocarcinoma, remain very difficult to treat, and are mostly diagnosed only at a stage that is too late for surgery, which is the only curative treatment. Pancreatic cancer is rare in people younger than 40 and the median age of diagnosis is 71. Risk factors include chronic pancreatitis, older age, smoking, obesity, diabetes, and certain rare genetic conditions including multiple endocrine neoplasia type 1, hereditary nonpolyposis colon cancer and dysplastic nevus syndrome among others. About 25% of cases are attributable to tobacco smoking, while 5-10% of cases are linked to inherited genes.

Pancreatic adenocarcinoma is the most common form of pancreatic cancer, and is cancer arising from the exocrine digestive part of the pancreas. Most occur in the head of the pancreas. Symptoms tend to arise late in the course of the cancer, when it causes abdominal pain, weight loss, or yellowing of the skin ( jaundice). Jaundice occurs when the outflow of bile is blocked by the cancer. Other less common symptoms include nausea, vomiting, pancreatitis, diabetes or recurrent venous thrombosis. Pancreatic cancer is usually diagnosed by medical imaging in the form of an ultrasound or CT scan with contrast enhancement. An endoscopic ultrasound may be used if a tumour is being considered for surgical removal, and biopsy guided by ERCP or ultrasound can be used to confirm an uncertain diagnosis.

Because of the late development of symptoms, most cancer presents at an advanced stage. Only 10 to 15% of tumours are suitable for surgical resection. As of 2018, when chemotherapy is given the FOLFIRINOX regimen containing fluorouracil, irinotecan, oxaliplatin and leucovorin has been shown to extend survival beyond traditional gemcitabine regimens. For the most part, treatment is palliative, focus on the management of symptoms that develop. This may include management of itch, a choledochojejunostomy or the insertion of stents with ERCP to facilitate the drainage of bile, and medications to help control pain. In the United States pancreatic cancer is the fourth most common cause of deaths due to cancer. The disease occurs more often in the developed world, which had 68% of new cases in 2012. Pancreatic adenocarcinoma typically has poor outcomes with the average percentage alive for at least one and five years after diagnosis being 25% and 5% respectively. In localized disease where the cancer is small (< 2 cm) the number alive at five years is approximately 20%.

There are several types of pancreatic cancer, involving both the endocrine and exocrine tissue. The many types of pancreatic endocrine tumors are all uncommon or rare, and have varied outlooks. However the incidence of these cancers has been rising sharply; it is not clear to what extent this reflects increased detection, especially through medical imaging, of tumors that would be very slow to develop. Insulinomas (largely benign) and gastrinomas are the most common types. For those with neuroendocrine cancers the number alive after five years is much better at 65%, varying considerably with type.

A solid pseudopapillary tumour is a low-grade malignant tumour of the pancreas of papillary architecture that typically afflicts young women.

Type 1 diabetes

Diabetes mellitus type 1 is a chronic autoimmune disease in which the immune system attacks the insulin-secreting beta cells of the pancreas. Insulin is needed to keep blood sugar levels within optimal ranges, and its lack can lead to high blood sugar. As an untreated chronic condition, complications including accelerated vascular disease, diabetic retinopathy, kidney disease and neuropathy can result. In addition, if there is not enough insulin for glucose to be used within cells, the medical emergency diabetic ketoacidosis, which is often the first symptom that a person with type 1 diabetes may have, can result. Type 1 diabetes can develop at any age but is most often diagnosed before age 40. For people living with type 1 diabetes, insulin injections are critical for survival. An experimental procedure to treat type 1 diabetes is pancreas transplantation or isolated transplantation of islet cells to supply a person with functioning beta cells.

Type 2 diabetes

Diabetes mellitus type 2 is the most common form of diabetes. The causes for high blood sugar in this form of diabetes usually are a combination of insulin resistance and impaired insulin secretion, with both genetic and environmental factors playing a role in the development of the disease. Over time, pancreatic beta cells may become "exhausted" and less functional. The management of type 2 diabetes involves a combination of lifestyle measures, medications if required and potentially insulin. With relevance to the pancreas, several medications act to enhance the secretion of insulin from beta cells, particularly sulphonylureas, which act directly on beta cells; incretins which replicate the action of the hormones glucagon-like peptide 1, increasing the secretion of insulin from beta cells after meals, and are more resistant to breakdown; and DPP-4 inhibitors, which slow the breakdown of incretins.

It is possible for a person to live without a pancreas, provided that the person takes insulin for proper regulation of blood glucose concentration and pancreatic enzyme supplements to aid digestion.

The pancreas was first identified by Herophilus (335-280 BC), a Greek anatomist and surgeon. A few hundred years later, Rufus of Ephesus, another Greek anatomist, gave the pancreas its name. Etymologically, the term "pancreas", a modern Latin adaptation of Greek πάγκρεας, [πᾶν ("all", "whole"), and κρέας ("flesh")], originally means sweetbread, although literally meaning all-flesh, presumably because of its fleshy consistency. It was only in 1889 when Oskar Minkowski discovered that removing the pancreas from a dog caused it to become diabetic. Insulin was later isolated from pancreatic islets by Frederick Banting and Charles Best in 1921.

The way the tissue of the pancreas has been viewed has also changed. Previously, it was viewed using simple staining methods such as H&E stains. Now, immunohistochemistry can be used to more easily differentiate cell types. This involves visible antibodies to the products of certain cell types, and helps identify with greater ease cell types such as alpha and beta cells.

Pancreatic tissue is present in all vertebrates, but its precise form and arrangement varies widely. There may be up to three separate pancreases, two of which arise from the pancreatic bud, and the other dorsally. In most species (including humans), these "fuse" in the adult, but there are several exceptions. Even when a single pancreas is present, two or three pancreatic ducts may persist, each draining separately into the duodenum (or equivalent part of the foregut). Birds, for example, typically have three such ducts.

In teleost fish, and a few other species (such as rabbits), there is no discrete pancreas at all, with pancreatic tissue being distributed diffusely across the mesentery and even within other nearby organs, such as the liver or spleen. In a few teleost species, the endocrine tissue has fused to form a distinct gland within the abdominal cavity, but otherwise it is distributed among the exocrine components. The most primitive arrangement, however, appears to be that of lampreys and lungfish, in which pancreatic tissue is found as a number of discrete nodules within the wall of the gut itself, with the exocrine portions being little different from other glandular structures of the intestine.

Barrett, Kim E. (2019). Ganong's review of medical physiology. Barman, Susan M.,, Brooks, Heddwen L., Yuan, Jason X.-J. (26th ed.). New York. ISBN 9781260122404. OCLC 1076268769.

Beger HG, ed. (2018). The pancreas : an integrated textbook of basic science, medicine, and surgery (third ed.). Hoboken, NJ. ISBN 978-1-119-18841-4. OCLC 1065547789.

Standring, Susan, ed. (2016). Gray's anatomy : the anatomical basis of clinical practice (41st ed.). Philadelphia. ISBN 9780702052309. OCLC 920806541.

# data[].attributes.attachment_link.description
The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e., it has both an endocrine and a digestive exocrine function.

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The reproductive system is a collection of organs and a network of hormone production that work together for the purpose of procreation, or creating offspring. It's present in both males and females, and each has distinct parts that collaborate in the process of reproduction.

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Testes: Two oval-shaped glands located in the scrotum that produce sperm (male reproductive cells) and testosterone (the primary male sex hormone).

Sperm: Microscopic male reproductive cells that can fertilize an egg.

Testosterone: A hormone responsible for development of male physical traits like facial hair and muscle mass, as well as sperm production.

Scrotum: The sac of skin that holds the testes outside the abdomen.

Epididymis: A coiled tube located on the top of each testis where sperm mature and are stored.

Vas deferens: A long, thin tube that carries mature sperm from the epididymis to the ejaculatory duct.

Ejaculatory ducts: Two tubes that join the vas deferens and seminal vesicles to form a single canal that empties sperm into the urethra.

Seminal vesicles: Two sac-like glands that produce seminal fluid, a nutrient-rich fluid that nourishes and protects sperm during ejaculation.

Prostate gland: A gland located below the bladder that produces a milky fluid that contributes to semen.

Urethra: A tube that carries urine from the bladder and semen from the seminal vesicles and prostate gland out of the body through the penis.

Penis: The male reproductive organ used for sexual intercourse and urination.

# data[].attributes.body
Ovaries: Two almond-shaped glands located in the lower abdomen that produce eggs (ova) and female sex hormones (estrogen and progesterone).

Egg (ovum): The female reproductive cell that can be fertilized by sperm.

Estrogen: A hormone responsible for development of female sexual characteristics like breasts and regulates the menstrual cycle.

Progesterone: A hormone that prepares the uterus for pregnancy and maintains the lining during pregnancy.

Fallopian tubes: Two tubes that connect the ovaries to the uterus. They are the site where fertilization (the union of sperm and egg) typically occurs.

Uterus: A hollow, pear-shaped muscular organ where a fertilized egg implants and develops into a fetus during pregnancy.

Cervix: The lower, narrow part of the uterus that opens into the vagina.

Vagina: A muscular canal that leads from the cervix to the outside of the body. It serves as the passage for menstrual flow, sexual intercourse, and childbirth.

Vulva: The external part of the female genitalia, including the mons pubis (the fatty mound covered with pubic hair), labia majora (outer lips), labia minora (inner lips), clitoris (a small, erectile tissue), and vestibule (the opening to the vagina and urethra).

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The urinary system is your body's filtration system, constantly working to remove waste products and excess water from your blood. It's like a complex plumbing network with each part playing a vital role in keeping your body clean and functioning properly

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Kidneys: Two bean-shaped organs located near your lower back, responsible for filtering waste products and excess water from your blood.

Waste products: Byproducts of cellular metabolism that need to be eliminated from the body.

Excess water: Extra fluid in the body that isn't required for immediate functions.

Ureters: Two thin tubes that carry urine, the filtered liquid waste, from the kidneys to the bladder.

Urine: A liquid waste product containing water, urea (a waste product from protein breakdown), and other dissolved salts and minerals.

Bladder: A muscular sac-like organ in your lower abdomen that stores urine until you release it through urination.

Urethra: A tube that carries urine from the bladder out of the body through the process of urination.

# data[].attributes.body
1. Filtration: The kidneys act as filtration units, constantly processing blood. They remove waste products like urea, excess water, and other unwanted substances.

2. Waste Removal: The filtered waste products and excess water are combined to form urine.

3. Storage: Urine travels down the ureters and fills the bladder, which acts as a storage tank.

4. Elimination: When the bladder reaches a certain fullness, muscles in the bladder wall contract, and the sphincter (muscular valve) at the urethra relaxes, allowing you to urinate and expel urine from the body.