Clinical Significance of Pancreatic Calcifications: A 15-Year Single Center Observational Study

Objective Pancreatic calcifications (PC) are considered specific for chronic pancreatitis (CP), but PC may also be present in non-CP diseases. The aims are to understand the pattern of calcifications in different diseases and to determine they were related to malignant diseases. Methods A retrospective study was performed including patients with PC or CP undergoing surgery in the Department of General Surgery of Ruijin Hospital from January 2003 to June 2018. Results PC were observed in 168 (4.5%) of the 3755 patients with pancreatic diseases. The majority of patients with PC had three kinds of CP (73.2%) while 26.8% had other five kinds of non-CP diseases. The incidences of PC in the pancreatic diseases were lower than these in previous studies. In patients with non-CP diseases, the incidence of PC in malignant intraductal papillary mucinous neoplasm (IPMN) was significantly higher than benign IPMN (8.3% vs. 0.7%, p = 0.004). In 204 patients with CP, pancreatic calcification (OR = 3.7), advanced age (> 55 years), high BMI (> 24 kg/m2), parenchymal atrophy and pancreatic mass were independent predictors for malignancy. In patients of CP wih pancreatic mass (n = 81), the ability of PC (OR = 28.6) to predict malignancy increased nearly sevenfold. Conclusion The disease spectrum with PC was very diverse but the incidences of PC in the pancreatic diseases were low. PC may be related to malignant IPMN in non-CP diseases and is related to malignancy in the patients with CP, including the cases without pancreatic mass.

Recommendations for the Management of Incidental Pancreatic Findings in Adults by the Canadian Association of Radiologists Incidental Findings Working Group

The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2021 Canadian guidelines for the management of pancreatic incidental findings. Topics covered include anatomic variants, fatty atrophy, pancreatic calcifications, ductal ectasia, and management of incidental pancreatic cysts.

13: LOW BODY MASS INDEX DIABETES IS CHARACTERIZED BY IMPAIRED INSULIN SECRETION

Purpose of StudyFibrocalculous Pancreatic Diabetes (FCPD) and Lean Diabetes (LD) are unique forms of diabetes affecting millions of people in developing countries, characterized by the presence or absence of pancreatic calcifications on ultrasound and insulin-requiring but ketosis-resistant diabetes. To optimize therapeutic strategies for FCPD and lean diabetes patients, it is imperative to conclusively assess their insulin secretion using gold-standard methodologies.Methods UsedComprehensive tests were undertaken in n=22 Indian males with FCPD (age 30±2 y, BMI 19.7±0.6 kg/m2, HbA1c 9.0±0.3%) and n=6 with LD (age 36±4 y, BMI 18.3±0.1 kg/m2, HbA1c 11.6±1.3%), and compared with n=12 age, BMI matched ND, n=16 T1D (HbA1c 9.1±0.3%) and n=12 T2D subjects (age 36±2 y, BMI 26.0±0.3 kg/m2, HbA1c 9.7±0.6%). Following correction of hyperglycemia for over two weeks, mixed-meal tolerance tests (MMTT) and C-peptide deconvolution analysis was performed to assess beta-cell function.Summary of ResultsGlucose and C-peptide responses to MMTT suggest subjects with FCPD (14.5±2.2 pmol/kg/min) and LD (15.0±2.9 pmol/kg/min) have markedly impaired insulin secretion relative to both ND and T2D (p<0.001), and not statistically different from T1D (figure 1).ConclusionsThus, we report the first studies showing that patients with low BMI diabetes have impaired insulin secretion despite correction of hyperglycemia, consistent with nutritional effects on beta cell development or function.Abstract 13 Figure 1

MP2: PATHOPHYSIOLOGY AND METABOLIC PHENOTYPE OF LOW BODY MASS INDEX DIABETES

Purpose of StudyMillions of individuals with low body mass index (BMI) globally have diabetes of unclear etiology. These include patients with Fibrocalculous Pancreatic Diabetes (FCPD) and Lean Diabetes (LD), defined by the presence or absence of pancreatic calcifications on ultrasound. We present the first studies using gold-standard methodologies to assess their metabolic phenotype.Methods UsedStepped euglycemic-hyperinsulinemic (∼30 and 80 mU/m2/min) clamp studies were performed in n=8 Indian males with LD (age 38±3 y, BMI 18.4±0.1 kg/m2, HbA1c 11.0±0.8%) and n=22 with FCPD (age 30±1 y, BMI 19.7±0.6 kg/m2, HbA1c 10.2±0.6%), compared with n=12 type 2 diabetes subjects (T2DM, BMI 25.7±0.3 kg/m2, HbA1c 9.7±0.6%) and n=12 age and BMI matched non-diabetic (ND) subjects and n=16 with type 1 diabetes (T1DM, HbA1c 9.1±0.3%). Therapeutic regimens were intensified for two weeks to correct glucose toxicity in all groups. Lean body mass was determined for all subjects from percentage of total body fat as assessed by DXA.Summary of ResultsPeripheral insulin sensitivity (Rd, mg/kg lean body weight/min), was markedly impaired in T2DM (2.3±0.6; p<0.01) compared to LD (9.2±1.6) and FCPD (5.8±0.7). Rd did not differ between T1DM (5.8±0.7), LD and FCPD groups (figure 1).ConclusionsThus, these comprehensive studies suggest patients with LD and FCPD are only mildly insulin resistant once hyperglycemia is corrected. This promotes a paradigm shift in our understanding of low body mass index diabetes and could have profound therapeutic implications for millions of people.Abstract MP2 Figure 1