Three cases of fibrocalculous pancreatic diabetes and review of literatures

Abstract

Objective To enhance the understanding of fibrocalculous pancreatic diabetes (FCPD) by reviewing its clinical features and auxiliary examination results. Methods Three patients in our hospital were reported in detail. Combined with the clinical data of 50 cases of FCPD had been reported in our country, the sex ratio of patients, age of onset, clinical features, laboratory examination, imaging characteristics and treatment were discussed through retrospective analysis. Results In total 53 cases, there were 37 male and 16 famale, the diagnose age was 27-60 years old. These patients were mainly distributed in Sichuan (18 cases), Guangxi (18 cases), and Guangdong (12 cases) province. Some scattered in Hainan (1 case), Guizhou (1 case), Hunan (1 case), Zhejiang (1 case) and Inner Mongolia (1 case). Edible cassava was in 11 cases, and drinking history in 4 cases. One patient was misdiagnosed as type 1 diabetes mellitus(T1DM) for 5 years, and the other 10 patients were diagnosed as type 2 diabetes mellitus(T2DM) for 2-6 years respectively. 33 cases had abdominal pain, 19 patients had steatorrhea. The calculus and fibrosis were confirmed by X-ray (11 case), B ultrasound (30 cases), computed tomography (35 cases), magnatic resonance imaging(MRI) and surgical pathology(1 case). Most of the patients (n=52) had low body weight. Admission random blood glucose levels were 14.0-30.8 mmol/L, plasm insulin and C-peptide were significantly decreased, but only 2 cases had ketosis. 51 cases were treated with insulin, only 2 cases were treated with sulfonylurea oral glucose-lower drugs to control blood sugar. Conclusions (1) The classic clinical symptoms of FCPD are abdominal pain, steatorrhea and diabetes but almost atypical. (2)Some findings, including low weight, high blood sugar, poor pancreas islet function and no ketosis, are helpful for making an early and accurate diagnosis. Calculus and fibrosis of pancreas through X-ray, B ultrasound, CT or MRI are useful for the final diagnosis. Key words: Diabetes mellitus; Calcification of pancreas; Fibrosis of pancreas