Blood levels of lipase, amylase, and trypsin occurring spontaneously and after pancreatic stimulation with secretin-pancreozymin (S-P) or morphine-Prostigmin (M-P) were measured in 200 normal subjects and patients with various types and stages of exocrine pancreatic disease. Maximum enzyme elevations occurred in two opposite conditions: after M-P stimulation in normal subjects, and spontaneously in patients with moderate acute pancreatitis. The lowest elevations occurred also in two opposite conditions: after S-P stimulation in patients with minimal disease, and in patients with extensive disease. Intermediate elevations occurred in patients with either mild or severe pancreatitis. The relation between magnitude of blood enzyme elevation and severity of pancreatic disease was thus found to be a combination of direct and inverse correlations; two possible interpretations always exist for the same enzyme value and must be clarified in terms of the type of stimulus, whether hormonal, pharmacologic, or inflammatory. This relationship is depicted graphically by a double-limb response curve which embodies the entire spectrum of health and disease and can be applied to stimulation tests of pancreatic function as well as to spontaneous enzyme values in disease. Stages of disease can be quantified by the degree of elevation of blood enzymes.
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Brooks FP: Current concepts: testing pancreatic function. N Engl J Med 286:300–303, 1972
Bockus HL, Lopusniak MS, Tachdjian V: Diagnostic procedures in the study of pancreatic disorders, Gastroenterology. Chap 123. Vol III. Edited by HL Bockus. Second edition. Philadelphia, WB Saunders Co, 1965, pp 893–917
Kowlessar OD: Diseases of the pancreas, Cecil-Loeb Textbook of Medicine. Edited by PB Beeson, W McDermott. Thirteenth edition. Philadelphia, WB Saunders Co, 1971, pp 1312–1327
Dreiling DA, Janowitz HD, Perrier CV: Pancreatic Inflammatory Disease: A Physiologic Approach. New York, Harper & Row, 1964, pp 117–124
Howard JM, Jordan GL Jr: Surgical Diseases of the Pancreas. Philadelphia, JB Lippincott Co, 1960, pp 124–142
Spiro HM: Clinical Gastroenterology. New York, The MacMillan Co, 1970, pp 791–816
Adams JT, Libertino JA, Schwartz SI: Significance of an elevated serum amylase. Surgery 63:877–884, 1968
Gibbs GE, Ivy AC: Early histological changes following obstruction of pancreatic ducts in dogs: correlation with serum amylase. Proc Soc Exp Biol Med 77:251–254, 1951
Hall ER, Howard JM, Jordan GL Jr, Witt R: A study of serum amylase concentration in patients with acute cholecystitis. Ann Surg 143:517–519, 1956
Bogoch AJ, Roth JLA, Bockus HL: The effects of morphine on serum amylase and lipase. Gastroenterology 26:697–708, 1954
Wapshaw H: The pancreatic side effects of morphine. Br Med J 1:373–375, 1953
Abruzzo JL, Homa M, Houck JC, Coffey RJ: Significance of the serum amylase determination. Ann Surg 147:921–930, 1958
Bernard HR, Criscione JR, Moyer CA: The pathologic significance of the serum amylase concentration. Arch Surg 79:311–316, 1959
Elliott DW, Williams RD: A re-evaluation of serum amylase determinations. Arch Surg 83:130–136, 1961
Trapnell JE, Anderson MC: Role of early laparotomy in acute pancreatitis. Ann Surg 165:49–55, 1967
Grossman MI: Experimental pancreatitis. Arch Intern Med 96:298–307, 1955
Berk JE: Diagnostic features of pancreatic disease. JAMA 159:1079–1085, 1955
MacNab I: Subacute pancreatitis. Br Med J 1:568–571, 1949
Sun DCH, Shay H: Pancreozymin-secretion test: the combined study of serum enzymes and duodenal contents in the diagnosis of pancreatic disease. Gastroenterology 38:570–581, 1960
- 20. a)
Tietz NW, Borden T, Stepelton JD: Improved method for determination of lipase in serum. Am J Clin Pathol 31:148–154, 1959.
- 20. b)
Tietz NW, Fiereck EA: A specific method for serum lipase determination. Clin Chim Acta 13:352–358, 1966
Bray WE: Clinical Laboratory Methods. Fifth edition. St. Louis, CV Mosby Co, 1957, p 349
Gullick HD: Differentiation of trypsin-like enzymes in human plasma. Clin Chem 18:1385–1394, 1972
Gullick HD: Increased plasma proteolytic activity due to arginine amidase in patients with pancreatitis. N Engl J Med 268:851–857, 1963
Gullick HD: Trypsin activity in blood and other body fluids, Technical Manual. Workshop on Clinical Enzymology, Commission on Contiuing Education, American Society of Clinical Pathologists, 1964, pp 193–207
Nardi GL: Serum trypsin determination in pancreatic disease. J Lab Clin Med 52:66–69, 1958
Nardi GL: Specific polypeptide substrates in enzymatic determination of pancreatic disease. Surgery 46:30–37, 1959
Gullick HD: Plasma amidase and amylase activity in patients undergoing operation. Surgery 57:230–240, 1965
Gullick HD, Schauble MK: SD unit system for standardized reporting and interpretation of laboratory data. Am J Clin Pathol 57:517–525, 1972
Studies supported by the General Medical Research Service, Veterans Administration.
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Gullick, H.D. Relation of the magnitude of blood enzyme elevation to severity of exocrine pancreatic disease. Digest Dis Sci 18, 375–383 (1973). https://doi.org/10.1007/BF01071986
- Acute Pancreatitis