THE DIAGNOSIS of chronic pancreatic disease constitutes a real challenge. The pancreas possesses tremendous reserve capacity, and, often after pathologic destruction or surgical removal of a large part of the gland, there may be a few signs of functional abnormalities. In many chronic affections of the pancreas, symptoms do not arise until the disease is far advanced. Furthermore, the diseased pancreas is usually inaccessible to palpation and rarely yields direct signs of abnormality by roentgen examination. It is obvious, therefore, that clinically feasible, if not simple, tests for impaired pancreatic function are needed.
A variety of laboratory procedures have been advocated in the past to obtain information of aid in the diagnosis of pancreatic disease. Many of the earlier tests have been discarded. The value of the serial serum amylase and lipase determinations in pancreatic disease is well recognized. However, clinical experience has shown that elevated blood values for