Pancreatic Functional Evaluation in Metabolic Syndrome

Abstract

Introduction: Metabolic Syndrome (MS) has insulin resistance as main metabolic alteration. Insulin secretion involves directly the islets of Langerhans, which are the endocrine component of the pancreas. Through interaction of the exocrine-endocrine axis, it affects the pancreatic acinus, which is the exocrine component of the gland. The Pancreolauryl Test (PLs) measures indirectly the exocrine function through the action of an enzyme, the specific pancreatic cholesterol esterase, inside the intestinal lumen. The Pancreatogram evaluates globally the pancreatic function. Objective: To evaluate in MS patients, in distinction to the control patients, the pancreatic exocrine-endocrine function. Methods: Patients of both genders, range (33-72) years old: control (n=30) and MS (n=41), diagnosed regarding the ATPIII criteria. The endocrine-exocrine axis was evaluated through: Pancreatogram: amplified oral glucose tolerance test, we determine the 0,30,60 and 120minutes post stimulation (mps) values in serum, of glucose(Glu) and Insuline(Ins). Also, amylase(Ami), pancreatic amylase(AMI-P) and lipase(LIP) activity at time 0. PLs: It's determined at 0,60,120,150,180,210,240 mps. We measure serum concentration of fluorescein, which is released from fluorescein dilaurate, substrate of the pancreatic enzyme. Statistic analysis: Student Test. InfoStat. p < 0,05 Results: results are shown at the table as Mean± Standard Deviation Results: Table 1 Conclusion: hyperglucemia with hyperinsulimenia at all points of the curve manifests insulin resistance in the fasting state (hepatic) and peripheral tissue resistance is put in evidence at points 30 and 60 of the Pancreatogram. The insulin values in MS patients double the control values. AMY and LIP activity in MS patients is within reference values, but AMI activity is significantly higher than the control at expense of the AMI-P isoenzyme, which suggests insulin's action in the pancreon. The classic hyperinsulinemia found in MS, would stimulate amylase secretion and would inhibit partially lipase secretion. PLs of MS patients were significantly lower than those of the control, in fact, 46% (19) showed results below the cut value (4,5 mg/l), evidence of a diminished exocrine function. These results show the need to perform a pancreatogram and the importance of evaluating insulin in MS patients. We proved the gland's alteration at its endocrine component, in the context of a syndrome based on an endocrine metabolic alteration.Figure 1