Diabetes Mellitus and Tropical Form of Chronic Calcific Pancreatitis in Thailand

Abstract

Six cases of chronic calcific pancreatitis in Thailand occurring in patients aged 13 to 22 years are reported. Protein malnutrition was a possible aetiologic factor. Abdominal pain was mild to moderate and intermittent and not a presenting feature. Severe diabetes mellitus was present at all. Extensive pancreatic calcification was seeen on abdominal X-ray.

Parathyroid scintigraphy, histopathology correlation in patients with tropical pancreatitis and coexisting primary hyperparathyroidism

“…Corrected serum calcium was above the normal range for all our patients as reported in other studies. [356] The mean calcium values were significantly higher among patients with PHPT and pancreatitis compared with patients with PHPT and no pancreatic involvement. This makes us believe that the mechanism of development of pancreatitis in PHPT is correlated to the degree of hypercalcemia.…”

“…There is a shift in the disease pattern in our study showing involvement of middle aged males, which is in line with other published data. [356] Diabetes in patients with TP may have a slow progressive course. It is usually ketosis resistant and is termed as fibro calcific pancreatic diabetes and follows an aggressive course to reach the endpoints of diabetes, pancreatic calculi and exocrine pancreatic dysfunction (steatorrhea) in the majority of cases.…”

“…[23] It is also commonly referred as “Pancreatic diabetes” characterized by a younger age onset, presence of large intraductal pancreatic calculi, more aggressive pancreatitis and a high incidence of pancreatic malignancy. Apart from protein energy malnutrition, a number of factors are implicated in the etiopathogenesis of TP such as pancreatic ductal anomalies, food toxicities (i.e., chronic cyanide toxicity from cassava) and possible genetic predisposition (serine protease inhibitor, Kazal type 1, N34S mutation and cystic fibrosis transmembrane conductance regulator mutation).…”

Tropical Chronic Pancreatitis

“…The pancreas was hard and nodular and the duct was dilated. In the 1960s and 1970s, there were reports of a similar syndrome from other countries in Asia (Bangladesh, Sri Lanka, Thailand, and Malaysia), Africa (Nigeria, Uganda, Burundi, Zaire, and Malawi), and South America (Brazil) [4][5][6][7][8][9][10][11][12][13][14][15][16]. In 1955, Zuidema described 18 cases of disseminated pancreatic calcification in young nonalcoholic individuals in Indonesia [2].…”