Elevated Plasma Glucagon Levels in Cirrhosis of the Liver

Plasma glucagon levels (in the basal state, after stimulation with arginine and after suppression by oral glucose) were determined in 36 patients with cirrhosis. The mean basal glucagon levels were 455 ± 63 (S.E.M.) pg per milliliter in eight patients with portacaval shunts, 217 ± 23 pg per milliliter in 28 patients without shunts, and 146 ± 10 pg per milliliter in 15 controls. After arginine stimulation, glucagon rose to 828 ± 122 pg per milliliter in 25 cirrhotic patients and to 409 ± 36 pg per milliliter in the controls. High fasting glucagon levels (490 to 560 pg per milliliter) and an exaggerated elevation after arginine were also found in a noncirrhotic subject with a mesocaval shunt. Since glucagon is degraded in the liver, the abnormal liver-cell function and hepatic blood flow of cirrhosis probably explain the hyperglucagonism found in this condition. The high plasma glucagon levels, however, do not necessarily explain the abnormalities of carbohydrate tolerance found in patients with cirrhosis. (N Engl J Med 289:1107–1111, 1973)