It is a process of experimentation with the spontaneous, nonreactive elements that can be experienced in relationship with others.Working through abandonment depression is a complicated, lengthy and conflicted process that can be an enormously painful experience in terms of what is remembered and what must be felt. It involves mourning and grieving for the loss of the illusion that the patient had adequate support for the emergence of the real self. There is also a mourning for the loss of an identity, the false self, which the person constructed and with which he or she has negotiated much of his or her life. The dismantling of the false self requires relinquishing the only way that the patient has ever known of how to interact with others. This interaction was better than not to have a stable, organized experience of the self, no matter how false, defensive or destructive that identity may be. The dismantling of the false self "leaves the impaired real self with the opportunity to convert its potential and its possibilities into actualities." Working through brings unique rewards, of which the most important element is the growing realization that the individual has a fundamental, internal need for relatedness that may be expressed in a variety of ways.
Somatostatinomas are a tumor of the delta cells of the endocrine pancreas that produces somatostatin. Increased levels of somatostatin inhibit pancreatic hormones and gastrointestinal hormones. Thus, somatostatinomas are associated with mild diabetes mellitus (due to inhibition of insulin release), steatorrhoea and gallstones (due to inhibition of cholecystokinin release), and achlorhydria (due to inhibition of gastrin release). Somatostatinomas are commonly found in the head of pancreas. Only ten percent of somatostatinomas are functional tumours [9], and 60–70% of tumours are malignant. Nearly two-thirds of patients with malignant somatostatinomas will present with metastatic disease. Pathophysiology
In a normal subject, actions of somatostatin include:
In the anterior pituitary gland, the effects of somatostatin are:Inhibit the release of growth hormone, thus opposing the effects of growth hormone-releasing hormone (GHRH)
Inhibit the release of thyroid-stimulating hormone (TSH)Somatostatin suppresses the release of gastrointestinal hormonesGastrin
Cholecystokinin (CCK)
Secretin
Motilin
Vasoactive intestinal peptide (VIP)
Gastric inhibitory polypeptide (GIP)
EnteroglucagonLowers the rate of gastric emptying, and reduces smooth muscle contractions and blood flow within the intestine
Suppresses the release of pancreatic hormonesInhibits the release of insulin
Inhibits the release of glucagonSuppresses the exocrine secretory action of pancreas.This explains how abnormally elevated somatostatin can cause diabetes mellitus, by inhibiting insulin secretion, steatorrhoea by inhibiting cholecystokinin and secretin, gall stones by inhibiting cholecystokinin which normally induce gallbladder myocytes to contract, and hypochlorhydria caused by inhibiting gastrin, which normally stimulate acid secretion.Somatostatinomas are associated with calcium deposits called psammoma bodies.