Abstract
A new radioimmunoassay to serum trypsinogen (Cis Trypsik) was tested in several patient populations. A low serum trypsinogen level (<10 ng/ml) was found in 69.2% of 13 patients with chronic pancreatic insufficiency (CPI), in 100% of 10 patients with 95–100% pancreatectomy but only in 14% of 14 patients with cancer of the pancreas. A low trypsinogen level was not found in any of 68 control subjects or 10 patients with nonpancreatic steatorrhea. Nine patients with CPI or 95% pancreatectomy were retested a mean of six months after initial testing. Four of these nine (44.4%) had a significant variation in serum trypsinogen which would have led to a different diagnostic interpretation (two went from low to normal levels and two from normal to low levels). A mixed meal had little effect on serum trypsinogen levels in five of six patients with CPI, and pancreatic enzyme replacement therapy had no consistent effect on the serum trypsinogen level in seven patients with CPI or 95% pancreatectomy. It is speculated that minor subclinical episodes of focal pancreatitis may effect the serum trypsinogen level. Although there can be considerable variability using this assay, it still offers important clinical utility. A low trypsinogen level points to a chronic pancreatic process with excellent specificity. A normal trypsinogen level is of no help and should be repeated if clinical suspicion of chronic pancreatitis remains high.
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Elias E, Redshaw M, Wood T: Diagnostic importance of changes in circulating concentrations of immunoreactive trypsin. Lancet 2:66–68, 1977
Adrian TE, Besterman HS, Mallinson CN, Pera A, Redshaw MR, Wood TP, Bloom SR: Plasma trypsin in chronic pancreatitis and pancreatic adenocarcinoma. Clin Chim Acta 97:205–212, 1979
Gullo L, Ventrucci M, Bonora G, Gori G, Vezzadini P: Comparative study of serum trypsin levels and pancreatic exocrine function in chronic pancreatitis. Scand J Gastroenterol 15(Suppl 62):27–28, 1980
Koop H, Lankisch PG, Stockmann F, Arnold R: Trypsin radioimmunoassay in the diagnosis of chronic pancreatitis. Digestion 20:151–156, 1980
Lake-Bakaar G, McKavanagh S, Gatus B, Summerfield JA: The relative values of serum immunoreactive trypsin concentration and total amylase activity in the diagnosis of mumps, chronic renal failure and pancreatic disease. Scand J Gastroenterol 15:97–101, 1980
Ruddell WSJ, Mitchell CJ, Hamilton I, Leek JP, Kelleher J: Clinical value of serum immunoreactive trypsin concentration. Br Med J 283:1429–1430, 1981
Andriulli A, Masoero G, Felder M, Vantini I, Petrillo M, Cavallini G, Bianchi Porro G, Dobrilla G, verme G: Circulating trypsin-like immunoreactivity in chronic pancreatitis. Dig Dis Sci 26:532–537, 1981
Fahrenkrug J, Magid E: Concentration of immunoreactive trypsin and activity of pancreatic isoamylase in serum compared in pancreatic diseases. Clin Chem 26:1573–1576, 1980
Jacobson D, Curington C, Connery K, Toskes P: Trypsin-like immunoreactivity as a test of pancreatic exocrine deficiency. N Engl J Med 310:1307–1309, 1984
Amman RW, Buhler H, Pei P: Comparative diagnostic accuracy of four tubeless pancreatic function tests in chronic pancreatitis. Scand J Gastroenterol 17:997–1002, 1982
Malvano R, Marchisio M, Massaglia A, Giacosa PA, Zannino M, Andriulli A, Burlina A: Radioimmunoassay of trypsin-like substance in human serum. Scand J Gastroenterol 15(Suppl 62):3–10, 1980
Masoero G, Andriulli A, Bianco A, Benitti V, Marchetto M, De La Pierre M: Diagnostic accuracy of serum cationic trypsinogen estimation for pancreatic diseases. Dig Dis Sci 27:1089–1094, 1982
Steinberg WM, Goldstein SS, Davis ND, Anderson KK, Shamma'a JM: The meaning of a low serum trypsinogen. Dig Dis Sci 28:949, 1983
Moffat A, Marks V, Gamble DR: Serum immunoreactive trypsin concentrations in diabetic children. J Clin Pathol 33:871–875, 1980
Jacobson D, Tillman R, Toskes P, Curington C: Acute and chronic feedback inhibition of pancreatic exocrine secretion in human subjects. Gastroenterology 82:1091, 1982
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Steinberg, W.M., Anderson, K.K. Serum trypsinogen in diagnosis of chronic pancreatitis. Digest Dis Sci 29, 988–993 (1984). https://doi.org/10.1007/BF01311248
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DOI: https://doi.org/10.1007/BF01311248