Summary
Conclusion
Pancreatic endocrine capacities are remarkably disturbed in patients with pancreatic diabetes owing to calcific pancreatitis as opposed to those owing to noncalcific pancreatitis. Insulin secretion in calcific pancreatitis resembled, that in insulin-dependent diabetes mellitus (IDDM), whereas insulin secretion in noncalcific pancreatitis resembled that in non-IDDM (NIDDM). The involvements of acinar cell and ductal cell function closely correlate with endocrine function (insulin and glucagon secretions) in chronic pancreatitis (pancreatic diabetes).
Background
We sought to clarify the differences of pancreatic endocrine function between pancreatic diabetes and primary diabetes, and to verify the correlations between pancreatic exocrine and endocrine dysfunction in patients with chronic pancreatitis.
Methods
Urinary C-peptide (CPR) excretion and fasting plasma glucagon levels in patients with pancreatic diabetes owing to calcific pancreatitis (19 cases) and owing to noncalcific pancreatitis (14 cases) were studied in comparison with those in patients with insulin-dependent diabetes mellitus (IDDM, 23 cases), noninsulin-dependent diabetes (NIDDM, 18 cases), and in healthy controls (11 cases). In addition, pancreatic exocrine function was investigated in patients with chronic pancreatitis (calcific and noncalcific) and in healthy controls. The correlation between pancreatic exocrine and endocrine function was studied.
Results
The urinary CPR excetion in controls was 94.9±20.5 μg/d. The urinary CPR excretion in calcific pancreatitis was 12.8±7.4 μg/d and it resembled that in IDDM (9.4±5.8 μg/d). The urinary CPR excretion in noncalcific pancreatitis was 41.5±30.1 μg/d, being similar to that in NIDDM (49.3±21.0 μg/d).
The plasma glucagon level in calcific pancreatitis was 64.1±15.9 ρg/mL, which was significantly lower than the values in IDDM (111.2±50.2 ρg/mL) and NIDDM (96.7±21.9 ρg/mL). The plasma glucagon level in calcific and noncalcific pancreratitis (88.4±29.6 ρg/mL) were significantly lower than that in controls (12.9±21.6 ρg/mL).
The residual capacities of acinar cells and ductal cells were strongly correlated with urinary CPR excretion and plasma glucagon concentration.
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References
Bank S, Marks IN, Vinik AI. Clinical and hormonal aspects of pancreatic diabetes.Am J Gastroenterol 1975; 64: 13–22.
Del Prato S, Riva F, Devide A, Nosadini R, Fedele D, Tiengo A. Glucagon levels and ketogenesis in human diabetes following total or partial pancreatectomy and severe chronic pancreatitis.Acta Diabetol Lat 1980; 17: 111–118.
Muller WA, Berger M, Suter P, Cuppers JH, Reiter J, Wyss T, Berchtold P, Schmidt FH, Assal J-P, Renold AE. Glucagon immunoreactivities and amino acid profile in plasma of duodenopancreatectomized patients.J Clin Invest 1979; 63: 820–827.
Boden G, Master RW, Rezvani I, Palmer JP, Lobe TE, Owen OE. Glucagon deficiency and hyperaminoacidemia after total pancreatectomy.J Clin Invest 1980; 65: 706–716.
Joffe BI, Bank S, Marks IN. Hypoglycemia in pancreatitis. (letter).Lancet 1968; II: 1038.
Peters N, Dick AP, Hales CN, Orrell PH, Sarner M. Exocrine and endocrine pancreatic function in diabetes mellitus and chronic pancreatitis.Gut 1966; 7: 277–281.
Kalk WJ, Vinik AJ, Jackson WPU, Bank S. Insulin secretion and pancreatic exocrine function in patients with chronic pancreatitis.Diabetologia 1979; 16: 355–358.
Domschke S, Stock KP, Pichl J, Schneider MU, Domschke W. Beta-cell reserve capacity in chronic pancreatitis.Hepatogastroenterol 1985; 32: 27–30.
Keller U, Szöllösy E, Varga L, Gyr K. Pancreatic glucagon secretion and exocrine function (BT-PABA test) in chronic pancreatitis.Dig Dis Sci 1984; 29: 853–857.
Kasugai T, Kuno N, Kizu M, Kobayashi S, Hattori K. Endoscopic pancreato- cholangiography II. The pathological endoscopic pancreatocholangiogram.Gastroenterology 1972; 63: 227–234.
Axon ATR. Endoscopic retrograde cholangiopancreatography in chronic pancreatitis.Radiol Clin North Am 1989; 27: 39–50.
Sarner M, Cotton PB: Definitions of acute and chronic pancreatitis.Clin Gastroenterol 1984; 13: 865–870.
Kuzuya T, Matsuda A, Saito T, Yoshida S. Human C-peptide immunoreactivity (CPR) in blood and urine—Evaluation of a radioimmunoassay method and its clinical applications.Diabetologia 1976; 12: 511–518.
Sun DCH, Shay H. Pancreozymin-secretin test. The combined study of serum enzymes and duodenal contents in the diagnosis of chronic pancreatitis.Gastroenterology 1960; 38: 570–581.
Matsuda A, Kamata I, Iwamoto Y, Sakamoto Y, Kuzuya T. A comparison of serum C-peptide response to intravenous glucagon, and urine C-peptide, as indices of insulin dependence.Diabetes Res Clin Prac 1985; 1: 161–167.
Larsen S, Hilsted J, Tronier B, Worning H. Pancreatic hormone secretion in chronic pancreatitis without residual beta-cell functions.Acta Endocrinol 1988; 118: 357–364.
Andersen RN, Krarup T, Pedersen NT, Faber OK, Hagen C, Worning H. β cell function in patients with chronic pancreatitis and its relation to exocrine pancreatic function.Diabetologia 1982; 23: 86–89.
Malfertheiner P, Büchler M. Correlation of imaging and function in chronic pancreatitis.Radiol Pancreas 1989; 27: 51–64.
Persson I, Gyntelbery F, Helding LG, Boss-Nielsen J. Pancreatic glucagon-like immunoreactivity after intravenous insulin in normals and chronic pancreatitis patients.Acta Endocrinol 1971; 67: 401–404.
Assan R, Tiengo A. Comparison des secretions de glucagon dans les diabetes sucres avec ou sans pancreatopati organique acquise.Pathol Biol 1973; 21: 17–25.
Larsen S, Hilsted J, Philipsen EK, Tronier B, Christensen NJ, Nielsen DM, Worning H. Glucose counterregulation in diabetes secondary to chronic pancreatitis.Metabolism 1990; 39: 138–143.
Muller WA, Brennan MF, Tan MH, Aoki TT. Studies of glucagon secretion in pancreatectomized patients.Diabetes 1974; 23: 512–516.
Okumura N. Hayakawa T. Sakakibara A, Noda A, Kondo T. Plasma pancreatic glucagon response to blood glucose in experimental pancreatolithiasis in dogs.Diabetologia 1983; 25: 510–513.
Linde J, Nilsson LH, Barany FR. Diabetes and hypoglycemia in chronic pancreatitis. Scand J Gastroenterol 1977; 12: 369–373.
Donowitz M, Hendler R, Spiro HM, Binder HJ, Felig P. Glucagon secretion in acute and chronic pancreatitis.Ann Intern Med 1975; 83; 778–781.
Sjoberg RJ, Kidd GS. Pancreatic diabetes mellitus.Diabetes Care 1989; 12: 715–724.
Klöppel G, Bommer G, Commandeur G, Heitz Ph. The endocrine pancreas in chronic pancreatitis—Immunocytochemical and ultrastructural studies.Virchows Arch A (Pathol Anat and Histol) 1978; 377: 157–174.
Yeo CJ, Bastidas JA, Schmieg RE Jr, Walfisch S, Course N, Olson JL, Andersen DK, Zinner MJ. Pancreatic structure and glucose tolerance in a longitudinal study of experimental pancreatitis-induced diabetes.Ann Surg 1989; 210: 150–158.
Larsen S, Hilsted J, Tronier B, Worning H. Metabolic control and β cell function in patients with insulin-dependent diabetes mellitus secondary to chronic pancreatitis.Metabolism 1987; 36: 964–967.
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Nakamura, T., Imamura, Ki., Takebe, K. et al. Correlation between pancreatic endocrine and exocrine function and characteristics of pancreatic endocrine function in patients with diabetes mellitus owing to chronic pancreatitis. Int J Gastrointest Canc 20, 169–175 (1996). https://doi.org/10.1007/BF02803765
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DOI: https://doi.org/10.1007/BF02803765