BRIEF REPORTS Brief Reports Study on Some Exocrine and Endocrine Pancreatic Functions in Nephrotic Children Receiving Daily and Alternate-day Corticosteroids by El-Sayed H. Hassanein, MD, Soliman I. Soliman, MD, Hassan A. Hammad, MD, Aly Abd-El Aal, PhD, Nadia L. Hatem, MD, Ashraf T. Soliman, MD, and Amina El Halawany, MD Alexandria University, Children's Hospital, El Chatby, Alexandria, Egypt We measured the volume, pH, bicarbonate, and enzyme concentrations of duodenal aspirate, 12 before and after injection of secretin (1.0 Crick-Harper Raper Unit/kg body weight) as well as serum amylase and amylase/creatinine clearance ratio (A/CCR) [A/CCR = 100x(U amylase xS amylase) x S creat- ininexU creatinine], where U = urinary concentra- tion and S = serum concentration, in three groups of patients suffering from minimal change nephrotic syndrome (MCNS]. Twenty patients were newly diagnosed (group I), ten patients were relapsers receiving daily prednisone 2 mg/kg (group 2) (DCT) and ten patients were relapsers receiving prednisone 2 mg/kg every other day for the last 3 months (group 3). Oral glucose tolerance test was performed and the fasting concentrations of insulin and glucagon were measured by radioimmunoassay. After secretin provocation, the volume, pH, bicar- bonate, and amylase concentrations of the duodenal aspirates/20 min amongst nephrotic children receiving prednisone (groups 2 and 3) were significantly lower than those for the newly diagnosed patients. Trypsin concentration of the pancreatic juice was significantly decreased in nephrotic children on DCT. These effects could result from low grade pancreat- itis induced either by the pharmacological doses of steroids 3 and/or increased viscosity of the pancreatic secretions with back pressure on pancreatic parenchyma.* In support of this view serum amylase concentration and A/CCR value (> 5.0 is supportive to the diagnosis of pancreatitis) 5 is significantly elevated in patients on DCT. Correspondence: Dr Ashraf T. Soliman, Lecturer of Pedia- trics. Fasting serum insulin concentrations and insulin/ glucose ratios were significantly decreased in nephro- tic children on DCT. Their circulating glucagon concentrations and basal glucagon/insulin ratios were significantly higher than those for the other groups. This finding is compatible with direct affection of the endocrine pancreas with loss of the suppressive effect of insulin on glucagon secretion leading to hypergluca- gonemia and could explain, in part, the markedly raised fasting and peak circulating glucose concentra- tions in these patients compared to the other groups. In summary, corticosteroid therapy, especially on daily schedule, can depress the exocrine pancreatic secretion in response to secretin provocation and elevate serum amylase levels. Alterations of the endocrine functions of the pancreas as evidenced by low serum insulin and insulin/glucose ratio and hypergluconemia might disturb blood glucose homeostasis. References 1. De Core A, Guy O, Crotte C. Identification des enzymes du sue pancrcatique humain sur gel de polyacrylamide. Arch Fr Mai Appl Dig 1975; 64: 115-23. 2. Clemente F, De Caro A, Figarella C. Composition du sue pancreatique. Etude immunoenzymologique. Eur J Bio- chem 1972; 31: 186-93. 3. Riemenschneider TA, Wilson JF, Vernier RL. Glucocorti- coid induced pancreatitis in children. Pediat 1958; 41: 428-37. 4. Stumpf H H, Wilans SL, Somoza C. Pancreatic lesion and peripancreatic fat necrosis in cortisone treated rabbits. Lab Invest 1956; 5: 224-32. 5. Silverman A, Roy C. Pancreatitis. In: Pediatric clinical gastroenterology, 3rd edn. St Louis: The CV Mosby Company, 1983; 843-55. Journal of Tropical Pediatrics Vol.39 February 1993 © Oxford University Press 1992 37 at Hamad Medical Corporation on November 19, 2013 http://tropej.oxfordjournals.org/ Downloaded from