Relationship of Glucagon to Exocrine Pancreatic Secretion and Its Use in Acute Pancreatitis
Physiologic amounts of intravenously administered glucagon inhibit both exogenously (1, 2) (intravenous secretin and CCK) and endogenously (3) (small amounts of intraduodenal esential amino acids) stimulated exocrine pancreatic secretion. Furthermore, if endogenous glucagon secretion is stimulated by either delivering a large amino acid loan to the small intestine or by administering amino acids intravenously, exocrine pancreatic enzyme secretion is significantly reduced (3). Because glucagon inhibits exocrine pancreatic secretion during health and also during acute pancreatitis (4), it has been proposed as a therapeutic agent in the treatment of acute pancreatitis. However in prospective, randomized, clinical trials it is associated with the same mortality rate as treatment with placebo (5). In a recent small randomized control trial in patients with acute pancreatitis, the use of glucagon (5 kg/h) plus cimetidine (2 mg/kg/h) was associated with a greater incidence of complications than in patients treated with nasogastric suction or cimetidine in this same trial; the administration of cimetidine alone or with glucagon did not improve the outcome of acute pancreatitis when compared with nasogastric suction (5). Therefore although glucagon inhibits exocrine pancreatic secretion in health and in acute pancreatitis, it is not of benefit in the treatment of acute pancreatitis when used alone or in combination with cimetidine.
KeywordsPlacebo Pancreatitis Glucagon Cimetidine Aprotinin
- 5.M.R.C. (Medical Research Council) (1977) Multicentre trial of glucagon and aprotinin: death from acute pancreatitis. Lancet 2: 632–635Google Scholar