A Look Inside the Pancreas: The Endocrine-Exocrine Cross-talk?

Though the pancreas has traditionally been considered a combination of two separate organ systems, both the exocrine and endocrine portions are structurally and functionally interrelated. Disease processes diffusely involving the pancreas can give rise to both endocrine and exocrine dysfunctions and pancreatic diseases account for less than 0.5% of all cases of diabetes. Chronic pancreatitis and fibrocalculous pancreatic diabetes are the two most common diseases of the exocrine pancreas which can give rise to beta cell dysfunction and diabetes. On the contrary, prominent changes in the structure and functions of the exocrine pancreas have been identified in a significant number of the commonly encountered forms of diabetes, where exocrine insufficiency is unexpected otherwise. A number of hypotheses have been put forward by different workers at different time frames to explain the mechanisms of exocrine pancreatic insufficiency in patients with primary pancreatic endocrine dysfunction. Though the frequency of exocrine insufficiency seems quite high in the literature, paucity of data exists on the beneficial effect of enzyme supplementation in diabetes patients with/without exocrine abnormality.