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Case Report

A 25-year-old female with cystic fibrosis is diagnosed with chronic pancreatitis. She is at risk for all of the following complications except:
A. vitamin B12 deficiency
B. vitamin A deficiency
C. pancreatic carcinoma
D. niacin deficiency
E. steatorrhea
Answer / Explanation:

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The answer is D.
Chronic pancreatitis is a common disorder in any patient population with relapsing acute pancreatitis, especially patients with alcohol dependence, pancreas divisum, and cystic fibrosis. The disorder is notable for both endocrine and exocrine dysfunction of the pancreas. Often diabetes ensues as a result of loss of islet cell function; though insulin-dependent, it is generally not as prone to diabetic ketoacidosis or coma as are other forms of diabetes mellitus. As pancreatic enzymes are essential to fat digestion, their absence leads to fat malabsorption and steatorrhea.

In addition, the fat-soluble vitamins, A, D, E, and K, are not absorbed. Vitamin A deficiency can lead to neuropathy. Vitamin B12, or cobalamin, is often deficient. This deficiency is hypothesized to be due to excessive binding of cobalamin by cobalamin-binding proteins other than intrinsic factor that are normally digested by pancreatic enzymes. Replacement of pancreatic enzymes orally with meals will correct the vitamin deficiencies and steatorrhea. The incidence of pancreatic adenocarcinoma is increased in patients with chronic pancreatitis, with a 20-year cumulative incidence of 4%. Chronic abdominal pain is nearly ubiquitous in this disorder, and narcotic dependence is common. Niacin is a water-soluble vitamin, and absorption is not affected by pancreatic exocrine dysfunction.
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