Hyperglucagonemia in Laennec's Cirrhosis: The Role of Portal-Systemic Shunting

Abstract

Plasma pancreatic glucagon concentrations were determined in 18 cirrhotic patients in the basal state and after the infusion of alanine, 0.15 g per kilogram of body weight in two to four minutes. In the cirrhotic patients, basal concentrations of glucagon were two to five times normal, and the glucagon response to alanine administration was three to 13 times greater than in 11 control subjects. Glucagon levels were highest in four patients with portacaval anastomosis, were less elevated in 10 cirrhotic patients with spontaneous portal-systemic shunting and were normal in four cirrhotic patients without portal-systemic shunting. Glucagon concentrations correlated closely in all three groups with the degree of ammonia intolerance. Elevations of plasma tyrosine, methionine and phenylalanine were observed in the cirrhotic group, whereas the levels of branched chain amino acids (valine, leucine and isoleucine) were reduced. Hyperglucagonemia may contribute to the glucose intolerance observed in cirrhosis. (N Engl J Med 290:239–242, 1974)