[Pancreatic endocrine tumors with digestive effects. Physiopathological and clinical aspects]

Endocrine tumours of the gastro-intestinal tract, especially pancreatic, play an important role in the regulation of digestive function and in the embryogenesis of the endocrine cells of the body. Histologically, about 50 p. 100 of these tumours are composed of several types of endocrine cell. However, in the majority of cases, the clinical and biological syndrome that they produce is related to the hypersecretion of only one of the peptide hormones secreted. One point of interest is the lack of correlation between tumour size, plasma concentration of the secreted peptide hormones, the effects of these endocrine oversecretions on the target organ(s) and the severity of the clinical presentation. This suggests phenomena of adaptation at each stage (tumour, peritumoral tissues and target organ). The diagnosis of gastro-intestinal endocrine tumors has been significantly improved by the development of reliable radioimmunological assays of the digestive hormones and modern techniques of medical imagery (ultrasonography, CAT scanning, selective portal angiography, aspiration biopsy under ultrasonic control). The prognosis of these tumours which are often malignant is better than that of gastro-intestinal adenocarcinoma. This justifies therapeutic intervention with the twin aim of controlling the effects of endocrine hypersecretion and tumour reduction. Surgical excision of the tumour should always be considered; if the tumour process is malignant chemotherapy will be required currently based on the association of 5-fluoro-uracil and streptozotocin.