Hyperinsulinism (organic or functional)

Hyperinsulinism (organic or functional) leads to an increase in glycogen fixation in the liver and muscles. As a result, an insufficient amount of glucose enters the blood. Insufficient supply of brain carbohydrates
(Normally, about 20% of the total glucose is consumed in brain function) reduces the transition of oxygen into it and leads to a functional disruption, first of all, of higher nervous activity, and then other brain functions, up to development in its cells, first of all, in most differentiated elements of the cortex, irreversible changes.

A deficiency of glucose in the body leads to the death of nerve cells within a few hours.
An inadequate supply of the brain with glucose and oxygen leads to the excitation of the sympathetic section of the autonomic nervous system with a subsequent increase in the blood content of catecholamines (weakness, sweating, tachycardia, anxiety, irritability, tremor, etc.). Slowing down of oxidative processes and disturbance as a result of hypoglycemia of all types of metabolism in the brain lead to a loss of normal tone by the walls of the blood vessels of the brain. The latter circumstance is the reason for their expansion and increase in permeability not only under the influence of the action of catecholamines, but also due to an increased influx of blood to the brain due to the narrowing of peripheral vessels.

Expansion of the vessels and an increase in their permeability lead to the development of cerebral edema, slowing the speed of blood flow, the formation of blood clots with the subsequent development of atrophic and degenerative changes in different parts of the brain.
Pathological anatomy. Tumors of the pancreatic islets occur in approximately 1% of all autopsies. They are located with the same frequency in the tail, head and body of the pancreas. Sometimes islet tumors (insulinomas) are located outside pancreatic – in the wall of the duodenum, the spleen gates, etc. The size of insulin varies from 2 mm to 10 cm and very rarely up to 15 cm. Tumors are usually single, have a rounded shape, color from dark cherry to greyish yellow. Tumors of the pancreatic islets are usually dense, sometimes cartilaginous. Sometimes the tumors are soft, which is the result of extensive hemorrhages in the parenchyma but the formation of cysts. Insulinomas are more common.

Benign, rarely malignant (about 10% of all insulin). Functional insulinomas account for 5 0% of all tumors of pancreatic islet p-cells. When insulinomas are malignant, metastasis usually occurs in the liver. Most often, insulinomas have parenchymal and fibrous structure, less often – mixed (parenchymal-fibrous).

Most insulinoma cells are degranulated. In the departments adjacent to the insulin, intensive hyperplastic and proliferative processes are observed (an increase in the number and size of pancreatic islets, hypertrophy of p-cells with the content of large nuclei in them, degranulation of many cells). A pronounced hyperplastic process is observed in the acinous tissue and in the pancreatic islets of the entire pancreas (hyperplasia and hypertrophy of the acinar duct, enhancing the process of cytogenesis of p-cells). In patients with deceased are also swelling of the brain. Histological examination of the brain reveals diffuse changes in nerve cells.

local_offerevent_note February 27, 2019

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