Lack of accuracy of plasma alpha-amino nitrogen profiles as an indicator of exocrine pancreatic function both after continuous and bolus stimulation of the pancreas with secretin and cholecystokinin-pancreozymin.
BACKGROUND
The reduced decrease of plasma alpha-amino nitrogen after hormonal stimulation of the pancreas has been characterized as a valid and simple test of pancreatic function. Aim of this study was to reassess the clinical value of the alpha-amino nitrogen test and to evaluate the role of different modes of hormonal secretion. Therefore, we have investigated the relationship of plasma alpha-amino nitrogen responses and pancreatic secretion, stimulated by either bolus injection (n = 25) or continuous infusion (n = 32) of cholecystokinin-pancreozymin in patients with and without exocrine pancreatic insufficiency as determined by the secretin-pancreozymin test. Of the 57 patients referred to the secretin-pancreozymin-test, 18 had pancreatic insufficiency, each 9 in the group with continuous and bolus stimulation.


RESULTS
Basal alpha-amino nitrogen concentrations were almost identical in patients with and without impaired pancreatic function (2.66 +/- 0.12 mmol/l vs. 2.73 +/- 0.08 mmol/l [SEM]; p > 0.05). Both, the bolus dose and infusion of cholecystokinin induced similar (log-normally distributed) maximum decreases of alpha-amino nitrogen concentrations (-SD; mean; + SD: 3.6; 9.0; 22.3% vs. 6.0; 10.5; 18.5%, respectively) in the patients without exocrine pancreatic insufficiency. This was in tendency more pronounced compared to those with impaired pancreatic secretion (cholecystokinin bolus; 2.7; 5.2; 9.9%; infusion: 5.0; 7.7; 11.6%). The difference (+/- exocrine pancreatic insufficiency) was significant (p < 0.05) for the infusion mode only. Moreover, the time course of alpha-amino nitrogen concentration-profiles was more homogenous after hormone infusion as compared to bolus stimulation. Sensitivities to detect exocrine pancreatic insufficiency by the alpha-amino nitrogen test were < 50% with either test modification.


CONCLUSIONS
The decrease of plasma alpha-amino nitrogen after stimulation with cholecystokinin is no accurate indicator of exocrine pancreatic function, regardless of whether hormonal stimulation is by bolus or by infusion.
Lembcke
B
B
Center of Internal Medicine, Johann Wolfgang Goethe-University Frankfurt/M, Germany.
Konle
O
O
Duan
L P
LP
Caspary
W F
WF
D000328:Adult; D000368:Aged; D002766:Cholecystokinin; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D010186:Pancreatic Function Tests / Q000379:methods*; D010189:Pancreatic Juice / Q000737:chemistry; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis*; D012016:Reference Values; D012633:Secretin
D012633:Secretin; D002766:Cholecystokinin