FIBROCALCULOUS PANCREATIC DIABETES

Fibrocalculous pancreatic diabetes (FCPD) is a unique form of diabetes secondary to chronic pancreatitis seen in developing countries of the world associated with either overt protein-calorie malnutrition or, m ore likely, with deficiency of certain micronutrients. FCPD affects yo ung individuals and runs an aggressive course to reach the endpoints o f diabetes, pancreatic calculi and exocrine pancreatic dysfunction (st eatorrhoea) in the majority of cases. There are characteristic feature s of FCPD radiologically, ultrasonographically, on endoscopic retrogra de cholangiopancreatography and on histopathology which distinguish it from chronic pancreatitis of other aetiologies seen in temperate zone s, e.g. alcoholic chronic pancreatitis. Although a secondary form of d iabetes, specific diabetes-related complications like retinopathy and nephropathy do occur in FCPD. There appears to be a high risk of devel oping pancreatic carcinoma. Although the aetiology of FCPD is still un clear, the role of micronutrient (antioxidant) deficiency is emerging as a possible aetiological or predisposing factor. The contribution of genetic factors and environmental toxins, e.g. cyanogenic glycosides or other nutritional/toxic factors, merit further study. Studies on FC PD, a good model of a secondary form of diabetes, could lead to improv ed understanding of other primary forms of diabetes as well. If the un derlying aetiological factors are identified, it may also be possible to prevent this type of diabetes. (C) 1998 John Wiley & Sons, Ltd.