Abdominal pain is called a nonspecific symptom. There are many things that can cause abdominal pain -- from myriad digestive problems, to reproductive issues, and even heart attacks or pneumonia. So, it is difficult to characterize pain as coming from the pancreas unless there is a known lesion of the pancreas. Pancreatic pain does tend to be centrally located and radiate to the back, however. Certain types of problems with the pancreas can also cause problems with insulin.
Growths
Pain emanating from the pancreas can come from a number of disease processes, although these disease processes can also be present without pain. Tumors, or neoplasms, are an overgrowth of tissue. If the growth does not invade the surrounding tissues, it is known as a benign tumor. If it invades, and especially if it spreads, it is cancerous. Any type of tissue in the pancreas can become a neoplasm. The insulin producing cells, known as beta cells, can become overgrown, causing a tumor known as an insulinoma. These tumors usually do not cause pain, but the high insulin can cause problems from low blood sugar. In addition, cancerous tumors can overtake neighboring tissues, destroy it, including insulin-producing cells, and lead to low levels of insulin. The invasion of nerves can cause pain.
Tissue Damage
Many conditions other than neoplasms can cause tissue damage in the pancreas that can lead to pain and changes in insulin and pancreatic function. Infections, toxins, trauma, gallstones, and drugs are examples of causes of pancreatitis, or inflammation of the pancreas. Pancreatitis can be acute -- quick onset and severe -- or chronic, which is slow onset and ongoing. In either case, the pain may radiate to the back and damage the endocrine and exocrine functions.
Functions
Endocrine functions of the pancreas refer to the release of hormones into the bloodstream by the pancreas. For example, insulin is released in response to a meal. The nutrients from a meal are absorbed through the gastrointestinal tract into the bloodstream, and the insulin signals cells to take up the nutrients. Exocrine refers to secretion of a substance into a duct. The pancreas secretes digestive enzymes into the intestine. Disruption of these functions can result from diseases causing pancreatic pain, such as tumors or pancreatitis.
Diagnosis
The diagnosis of pancreatic pain and insulin problems begins with a medical history. The time-course and character of the pain is determined, as well as any exacerbating or alleviating factors. Hypoglycemia, as from excessive insulin, corresponds to Whipple's triad: symptoms such as weakness, confusion or lightheadedness; low glucose at the time the symptoms occur; and reversal of symptoms when glucose is administered. A physical exam can also help characterize any problems, for example, if there is pain on touching the stomach or presence of a mass. Lab tests can reveal abnormalities in the blood from hormone imbalances and imaging, such as a CT scan, may reveal pancreatitis or growths. The treatment of the various conditions depends on the cause and should be discussed with a physician.
References
- "Robbins and Cotran Pathologic Basis of Disease"; Vinay Kumar, et al.; 8th Ed 2009
- "Harrison's Principles of Internal Medicine"; Anthony S Fauci, et al.; 17th Ed 2008
- "Physiology"; Linda S.Costanzo; 4th Ed 2008
