PANCREATIC FUNCTION TESTS

Pancreatic function tests are a group of diagnostic tests used to assess the health and
functionality of the pancreas. These tests are crucial for diagnosing various pancreatic disorders,
including pancreatitis, pancreatic insufficiency, and pancreatic cancer. The pancreas is
responsible for producing digestive enzymes and hormones, including insulin, that regulate
blood sugar levels. Therefore, any dysfunction can lead to digestive problems, malabsorption,
and metabolic disturbances.

Here are detailed notes on the Pancreatic Function Tests:

1. Serum Amylase

 Function: Amylase is an enzyme produced by the pancreas (and also the salivary glands)
that breaks down carbohydrates into sugars. Measuring serum amylase levels can help
diagnose pancreatic diseases.
 Clinical Significance:
o Acute Pancreatitis: Serum amylase levels typically rise within 6-12 hours of
acute pancreatitis onset and peak within 24 hours. Elevated levels may indicate
inflammation or damage to the pancreas.
o Pancreatic Cancer: May be elevated, although this is less specific.
o Other Conditions: Conditions like salivary gland infections, bowel obstruction,
and gastrointestinal perforations can also elevate amylase levels.
 Normal Range: Typically 23-85 U/L (depending on the laboratory). Values may vary
based on the testing method.

2. Serum Lipase

 Function: Lipase is an enzyme produced primarily by the pancreas that helps break down
fats into fatty acids and glycerol. It is more specific to the pancreas than amylase.
 Clinical Significance:
o Acute Pancreatitis: Lipase levels rise more specifically in acute pancreatitis and
remain elevated for a longer period than amylase. Lipase is generally elevated for
5-7 days after an acute pancreatitis event.
o Chronic Pancreatitis: Chronic inflammation of the pancreas may cause a gradual
decrease in lipase production, leading to lower levels over time.
o Pancreatic Cancer: May also be elevated but less commonly used as a diagnostic
marker for pancreatic cancer compared to other imaging studies.
 Normal Range: Generally 10-140 U/L (depending on the laboratory).
3. Fecal Elastase-1

 Function: Elastase-1 is a pancreatic enzyme secreted into the small intestine to help
digest proteins. It is highly stable in stool, making it an excellent marker for pancreatic
exocrine function.
 Clinical Significance:
o Pancreatic Insufficiency: Low fecal elastase-1 levels are indicative of pancreatic
insufficiency, where the pancreas does not secrete enough digestive enzymes.
This condition is commonly seen in chronic pancreatitis, cystic fibrosis, or after
pancreatic surgery.
o Malabsorption: Decreased levels can result in malabsorption of nutrients, leading
to weight loss, diarrhea, and nutrient deficiencies.
 Normal Range:
o Normal: >200 µg/g of stool.
o Mild Insufficiency: 100-200 µg/g of stool.
o Severe Insufficiency: <100 µg/g of stool.

4. Secretin-Cholecystokinin (CCK) Test

 Function: The secretin-CCK test is an invasive diagnostic procedure that evaluates the
ability of the pancreas to produce digestive enzymes. It involves infusing secretin and
CCK intravenously and collecting pancreatic juice via a tube inserted into the duodenum
to measure enzyme output.
 Clinical Significance:
o Pancreatic Exocrine Insufficiency: The test can diagnose exocrine pancreatic
insufficiency, a condition where the pancreas does not produce enough digestive
enzymes (e.g., in chronic pancreatitis or cystic fibrosis).
o Pancreatic Function Assessment: Helps assess the overall ability of the pancreas
to secrete digestive enzymes in response to hormonal stimulation.
 Normal Range: The enzyme output is measured by volume and concentration of
bicarbonate, amylase, and lipase. The results help determine if there is a deficiency in
enzyme secretion.

5. 72-Hour Fecal Fat Test

 Function: This test measures the amount of fat in the stool over a 72-hour period. It helps
assess the ability of the pancreas to produce lipase and other enzymes needed for fat
digestion.
 Clinical Significance:
o Malabsorption: High levels of fecal fat suggest malabsorption, a common result
of pancreatic insufficiency. Conditions like chronic pancreatitis or cystic fibrosis
can lead to insufficient pancreatic enzyme production.
 o Pancreatic Insufficiency: This is a key test for diagnosing pancreatic
insufficiency, where the pancreas does not secrete adequate digestive enzymes.
 Normal Range: Less than 7g of fat per day (for a normal diet).

6. Glucose Tolerance Test (GTT)

 Function: While primarily used to assess glucose metabolism and diagnose diabetes, the
GTT can also provide insights into pancreatic function, particularly in cases of pancreatic
dysfunction leading to impaired insulin secretion.
 Clinical Significance:
o Pancreatic Endocrine Function: The test assesses how well the pancreas
responds to glucose by measuring insulin and glucose levels after the
administration of a glucose load. Abnormal results can indicate insulin resistance,
pancreatic beta-cell dysfunction, or diabetes.
o Pancreatic Cancer: In some cases, pancreatic tumors can lead to glucose
intolerance or diabetes.
 Normal Range:
o Fasting Glucose: <100 mg/dL.
o 2-Hour Postprandial Glucose: <140 mg/dL.

7. C-Peptide Test

 Function: C-peptide is a byproduct of insulin production, and its levels reflect the
amount of insulin the pancreas is secreting.
 Clinical Significance:
o Pancreatic Insulin Production: C-peptide can be measured to assess how much
insulin the pancreas is producing. In patients with suspected insulin secretion
issues (like diabetes), this test helps determine if the pancreas is producing
insufficient insulin.
o Pancreatic Beta-Cell Function: The test can evaluate pancreatic beta-cell
function, which is vital for producing insulin.
 Normal Range:
o 0.5 to 2.0 ng/mL. C-peptide levels vary based on insulin secretion levels and may
be influenced by other factors like renal function.

8. Imaging Tests (CT Scan, MRI, Ultrasound)

 Function: While these are not direct pancreatic function tests, imaging techniques are
used to evaluate the structure and identify abnormalities in the pancreas.
 Clinical Significance:
 o Pancreatitis: Imaging can help diagnose pancreatitis, pancreatitis complications
(e.g., pseudocysts), and the extent of pancreatic damage.
o Pancreatic Cancer: Imaging is crucial in identifying pancreatic tumors, cysts,
and masses.
o Pancreatic Stones: Both CT and MRI can identify calcifications or stones in the
pancreas, which may indicate chronic pancreatitis.
 Normal Range: No masses, cysts, or calcifications should be visible in the pancreas on
imaging studies.

9. Pancreatic Biopsy

 Function: A biopsy involves taking a small tissue sample from the pancreas for
microscopic examination to identify abnormal cells, inflammation, or cancer.
 Clinical Significance:
o Pancreatic Cancer: It is the definitive test for diagnosing pancreatic cancer.
o Chronic Pancreatitis: Helps diagnose chronic pancreatitis by detecting fibrosis
and tissue damage.
 Normal Range: Normal pancreatic tissue without evidence of inflammation, fibrosis, or
malignancy.

10. Serum Trypsinogen

 Function: Trypsinogen is a precursor enzyme produced by the pancreas that is converted

into active trypsin in the small intestine to aid in protein digestion. Elevated levels of
trypsinogen in the blood can indicate acute pancreatitis.
 Clinical Significance:
o Acute Pancreatitis: High levels of serum trypsinogen can be indicative of acute
pancreatitis, particularly in the early stages before other enzymes like amylase or
lipase rise significantly.
 Normal Range: Generally <20 ng/mL, but this may vary depending on the assay method
used.

Conclusion:

Pancreatic function tests are essential for diagnosing and managing pancreatic disorders,
including both exocrine and endocrine dysfunctions. They help evaluate the ability of the
pancreas to secrete digestive enzymes, assess insulin production, and diagnose conditions such as
pancreatitis, pancreatic insufficiency, and pancreatic cancer. A combination of laboratory tests
(like serum amylase, lipase, fecal elastase, and glucose tolerance) along with imaging studies can
provide a comprehensive picture of pancreatic health, guiding appropriate treatment.