Definition
The human pancreas consists of two parts, called exocrine and endocrine. The exocrine part of the pancreas produces digestive enzymes and bicarbonate and releases its secretion through an excretory duct into the small intestine. The enzymes are used to break down the nutrients, while the bicarbonate neutralises the stomach acid contained in the food pulp.
The endocrine system produces either insulin or its antagonist glucagon, depending on the current blood sugar level. These hormones are not released into the intestines, but into the blood. If the function of one or both parts of the pancreas is impaired, the specialist speaks of an underfunctioning pancreas or pancreatic insufficiency. Frequently, only one of the two parts of the pancreas is impaired, which is why we speak of exocrine or endocrine pancreatic hypofunction. However, the latter term is rarely used, since it is simply diabetes mellitus (restricted insulin production).
Causes
The causes of pancreatic hypofunction are extremely varied. If only the endocrine (insulin-releasing) part is affected, this hypofunction is related to a diabetes mellitus disease. The insulin-producing pancreatic cells are either “depleted” due to age (diabetes type 2) or are attacked by autoantibodies (diabetes type 1).
The situation is different in exocrine pancreatic hypofunction. If it already occurs in childhood, it is usually the result of cystic fibrosis. In adults, by far the most common cause is acute or chronic inflammation of the pancreas (pancreatitis).
Acute inflammation is most often the result of the joint duct between the gallbladder and pancreas being blocked by a gallstone. This causes the secretion to back up and the enzymes contained in it to attack the pancreas itself. Chronic inflammation usually develops at the bottom of chronic alcohol consumption.
Diagnosis
With regard to the diagnosis of pancreatic hypofunction, a distinction must also be made between the exocrine and endocrine parts of the organ. For both diseases, the physician can already estimate the likelihood of pancreatic hypofunction by taking the patient’s medical history (patient interview) and conducting a physical examination. If endocrine hypofunction, i.e. a diabetes mellitus disease, is suspected, various tests are carried out to assess the functionality.
They are all based on the examination of the pancreas’s ability to keep the blood sugar level within the normal range. Suitable tests include measuring the blood sugar level on an empty stomach in the morning, determining the HbA1c value and performing an oGTT test (oral glucose tolerance test). In the latter, the test person is given a special sugary drinking solution and his or her blood sugar is measured one or two hours later.
To diagnose a possible exocrine pancreatic insufficiency, the concentration of the digestive enzyme elastase-1 and chymotrypsin in the stool is usually measured. A reduced occurrence of these enzymes in the stool indicates impaired production in the pancreas. This examination requires relatively little effort and usually provides satisfactorily reliable results.
Occasionally a secretin-pancreozymin test may be necessary. After administration of these hormones, the secretion performance of the pancreas is checked with the aid of a probe advanced to the small intestine. What is elastase anyway?
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