Physiology, Secretin


Article Author:
Nicholas DiGregorio


Article Editor:
Sandeep Sharma


Editors In Chief:
Linda Lindsay


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
Kristina Soman-Faulkner
Benjamin Eovaldi
Radia Jamil
Sobhan Daneshfar
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes


Updated:
12/30/2018 12:59:52 AM

Introduction

In collaboration with physiologist W. M. Bayliss, English physician E. H. Starling discovered secretin in 1902.[1] During that era, hormonal control of pancreatic secretions conflicted with the teachings of the Pavlov school that only neural reflexes were involved in pancreas response to duodenal acidification.[2] The findings of Bayliss and Starling remain as a scientific truth, but healthcare professionals have a better-developed understanding of secretin and its function.

Secretin is secreted by S cells in the duodenum and affects numerous other organ systems. Secretin receptors (SR) are expressed in the basolateral domain of several cell types.[3] Besides regulating the growth of epithelial cells in the pancreas and biliary system, secretin additionally exerts trophic effects.

Cellular

Initially, secretin begins as an amino acid precursor known as prosecretin until activation via gastric acid. Prosecretin contains an N-terminal peptide, spacer, secretin, and C-terminal peptide; while the N-terminal is a single peptide, secretin itself makes up residues 28 to 54, and the C-terminal peptide is 72-amino acids.[4] Secretin is a peptide hormone composed of 27 amino acids. The sequence is like that of a gastric inhibitory peptide (GIP), vasoactive intestinal peptide (VIP), and glucagon.

Secretin is produced in the duodenal mucosa and acts on the pancreas where it stimulates the release of bicarbonate and water. While this role in digestive physiology has been known, studies recently identified the mediating receptor function of secretin.[5] Along with the receptors of VIP and glucagon, the secretin receptor is part of the G-protein-coupled receptor superfamily. Pancreatic centroacinar cells have secretin receptors in their plasma membrane. Once bound to the receptor, secretin stimulates adenylate cyclase and converts ATP to cAMP. cAMP is a second messenger and causes the pancreas to secrete bicarbonate. The cAMP system plays a key role in the modulation of large biliary secretion since it is activated by secretin[6], as well as increased cholangiocyte proliferation.[7]

The mechanisms of secretin receptors signal termination involve phosphorylation[8], which are mediated by GPCR kinases [9]. The receptors are abundant on duct and acinar cells and moderate the release of secretin-stimulated fluid and bicarbonate secretion. Moreover, receptors are present in brain cells and neurons in the vagus nerve; secretin receptors are also found on tumors of the gastrointestinal (GI) tract.[10]

Function

Secretin has 3 main functions: regulation of gastric acid, regulation of pancreatic bicarbonate, and osmoregulation.

Regulation of Gastric Acid Secretion and Pancreatic Bicarbonate

The major physiological actions of secretin are stimulation of pancreatic fluid and bicarbonate secretion. S cells in the small intestine emit secretin. Gastric acid stimulates secretin release, allowing movement into the duodenal lumen. Secretin causes an increase in pancreatic and biliary bicarbonate secretion and a decrease in gastric H+ secretion. Secretin stimulates the secretion of bicarbonate-rich pancreatic fluid.[11] Secretin enters the intestinal lumen and stimulates bicarbonate secretion, ultimately neutralizing gastric H+, which plays an essential role in fat digestion by creating a more neutral (pH 6 to 8) environment. H+ and fatty acids in the duodenum regulate secretin release.

Secretin neutralizes the pH in the duodenum by optimizing the functionality of pancreatic amylase and pancreatic lipase. (1) Via the second messenger action of cAMP, bicarbonate release causes neutralization of the acidic environment, thus establishing a pH favorable for the action of digestive enzymes.[12] Secretin increases bicarbonate secretion from duodenal Brunner's gland as well; this mechanism buffers the acidity from chyme and reduces secretion of acid by parietal cells.

Osmoregulation

Water homeostasis is crucial in maintaining the balance between water intake and excretion in the body.

Osmoregulatory functions of secretin in the brain are similar to those of angiotensin II.[13] Secretin is found in the magnocellular neurons of the paraventricular and supraoptic nuclei of the hypothalamus. In states of elevated osmolality, secretin is released from the posterior pituitary - this causes activation of vasopressin release in the hypothalamus. Vasopressin affects the collecting ducts, where it induces the insertion of aquaporin 2 water channels on the apical membranes of these cells.[14] Secretin has been shown to induce an increase in urinary volume.

Related Testing

Clinically, the main use of secretin is in the diagnosis of gastrin-secreting tumors, such as in Zollinger-Ellison syndrome. Under normal physiologic conditions, secretin inhibits gastrin release; however, in gastrinoma pathologies, the administration of secretin will cause an overall increase in gastrin release. This idea is the basis for the secretin stimulation test, which is used to determine the presence of gastrin-producing tumors.[15] Proper technique of the secretin stimulation test places a tube down the throat through the stomach, and into the duodenum. Once the tube is in place, administration of exogenous secretin occurs, and analyzation of duodenal aspirations follow appropriately.

Secretin plays a role in diagnosing pancreatic insufficiency. Administration of secretin increases pancreatic secretions and causes dilation of pancreatic ducts. Therefore, secretin administration occurs during endoscopic retrograde cholangiopancreatography (ERCP) to aid in cannulization.[16] Recent studies show that secretin-enhanced ERCP is more efficacious in the evaluation of pancreatic secretions, and possible ductal obstruction.[17] Ultimately, secretin-enhanced ERCP is more useful in detecting inflammatory and neoplastic conditions of the pancreas versus the use of conventional methods such as magnetic resonance imaging or computerized tomography.

Pathophysiology

Despite the primary action of secretin being the bicarbonate secretion and production of pancreatic fluid[18], it also functions as an enterogastrone. Released by ingested fats, an enterogastrone is a substance that inhibits gastric acid secretion. Secretin inhibits gastric acid secretion.[19]

Similar to other intestinal peptides, secretin displays satiety-inducing features when administered.[20] Centrally, the action is controlled by the melanocortin system; peripherally, secretin signals through the sensory fibers of the vagus nerve.[21]

Abnormalities in secretin release parallel abnormalities in underlying pathologies, such as Syndrome of inappropriate antidiuretic hormone (SIADH). Patients with SIADH have normal vasopressin function, but undergo translocation of aquaporin 2; therefore, without the release of secretin from the posterior pituitary, no vasopressin release would occur due to lack of stimulation on the hypothalamus.

Clinical Significance

Cystic Fibrosis

Cystic fibrosis (CF) is a genetic disorder affecting multiple organs. CF is inherited in an autosomal recessive manner. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein cause it.[22] When the CFTR is not functioning correctly, secretions become thick and viscous. The disorder is characterized by epithelial secretory dysfunction, ductal obstruction lesions, and defective chloride permeability in the pancreas. Normally, the pancreas secretes chloride, bicarbonate, and water in response to secretin; however, in cystic fibrosis, this response is greatly diminished, thus causing dehydrated secretions and thickened mucus. Secretin-stimulated sonography and MRI can be used to diagnose exocrine pancreatic failure in cystic fibrosis.[23]

Autism and Pervasive Developmental Disorder

Recent studies hypothesize that secretin can be used to treat autism and pervasive developmental disorder (PDD). In a double-blind, placebo-controlled, crossover study, researchers gave a single dose of IV porcine secretin to participants. The study resulted in improved language and behavior in children with these disorders and chronic diarrhea. Children with chronic, active diarrhea showed a reduction in abnormal behaviors when treated with secretin.[24]


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Physiology, Secretin - Questions

Take a quiz of the questions on this article.

Take Quiz
Which of the following increases secretion of bicarbonate from pancreas?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following inhibits gastric acid secretion?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not true of secretin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not true of secretin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Secretin regulates the pH of the duodenum and stimulates bile production by the liver. What is the action of the bile following stimulation by secretin? What then acts on the product of bile's action?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the most potent stimulus for the secretion of secretin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 50-year-old female presents to the clinic with weight loss and diarrhea. Fluorescent analysis of the duodenum reveals damage to S cells. What hormone is most likely decreased?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Physiology, Secretin - References

References

Kopin AS,Wheeler MB,Leiter AB, Secretin: structure of the precursor and tissue distribution of the mRNA. Proceedings of the National Academy of Sciences of the United States of America. 1990 Mar     [PubMed]
Osnes M,Hanssen LE,Flaten O,Myren J, Exocrine pancreatic secretion and immunoreactive secretin (IRS) release after intraduodenal instillation of bile in man. Gut. 1978 Mar     [PubMed]
You CH,Rominger JM,Chey WY, Effects of atropine on the action and release of secretin in humans. The American journal of physiology. 1982 Jun     [PubMed]
You CH,Chey WY, Secretin is an enterogastrone in humans. Digestive diseases and sciences. 1987 May     [PubMed]
Cheng CY,Chu JY,Chow BK, Central and peripheral administration of secretin inhibits food intake in mice through the activation of the melanocortin system. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2011 Jan     [PubMed]
Chu JY,Cheng CY,Sekar R,Chow BK, Vagal afferent mediates the anorectic effect of peripheral secretin. PloS one. 2013     [PubMed]
Henriksen JH,de Muckadell OB, Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation. 2000 Oct     [PubMed]
Hirst BH, Secretin and the exposition of hormonal control. The Journal of physiology. 2004 Oct 15     [PubMed]
Chow BK, Molecular cloning and functional characterization of a human secretin receptor. Biochemical and biophysical research communications. 1995 Jul 6     [PubMed]
Brady CE 3rd, Secretin provocation test in the diagnosis of Zollinger-Ellison syndrome. The American journal of gastroenterology. 1991 Feb     [PubMed]
Catalano MF,Lahoti S,Geenen JE,Hogan WJ, Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointestinal endoscopy. 1998 Jul     [PubMed]
Khalid A,Peterson M,Slivka A, Secretin-stimulated magnetic resonance pancreaticogram to assess pancreatic duct outflow obstruction in evaluation of idiopathic acute recurrent pancreatitis: a pilot study. Digestive diseases and sciences. 2003 Aug     [PubMed]
Lee VH,Lee LT,Chu JY,Lam IP,Siu FK,Vaudry H,Chow BK, An indispensable role of secretin in mediating the osmoregulatory functions of angiotensin II. FASEB journal : official publication of the Federation of American Societies for Experimental Biology. 2010 Dec     [PubMed]
Afroze S,Meng F,Jensen K,McDaniel K,Rahal K,Onori P,Gaudio E,Alpini G,Glaser SS, The physiological roles of secretin and its receptor. Annals of translational medicine. 2013 Oct     [PubMed]
CHRISTODOULOPOULOS JB,JACOBS WH,KLOTZ AP, Action of secretin on pancreatic secretion. The American journal of physiology. 1961 Dec     [PubMed]
Nielsen S,DiGiovanni SR,Christensen EI,Knepper MA,Harris HW, Cellular and subcellular immunolocalization of vasopressin-regulated water channel in rat kidney. Proceedings of the National Academy of Sciences of the United States of America. 1993 Dec 15     [PubMed]
Alpini G,Glaser S,Robertson W,Rodgers RE,Phinizy JL,Lasater J,LeSage GD, Large but not small intrahepatic bile ducts are involved in secretin-regulated ductal bile secretion. The American journal of physiology. 1997 May     [PubMed]
Glaser S,Lam IP,Franchitto A,Gaudio E,Onori P,Chow BK,Wise C,Kopriva S,Venter J,White M,Ueno Y,Dostal D,Carpino G,Mancinelli R,Butler W,Chiasson V,DeMorrow S,Francis H,Alpini G, Knockout of secretin receptor reduces large cholangiocyte hyperplasia in mice with extrahepatic cholestasis induced by bile duct ligation. Hepatology (Baltimore, Md.). 2010 Jul     [PubMed]
O'Sullivan BP,Freedman SD, Cystic fibrosis. Lancet (London, England). 2009 May 30     [PubMed]
Engjom T,Tjora E,Wathle G,Erchinger F,Lærum BN,Gilja OH,Haldorsen IS,Dimcevski G, Secretin-stimulated ultrasound estimation of pancreatic secretion in cystic fibrosis validated by magnetic resonance imaging. European radiology. 2018 Apr     [PubMed]
Kern JK,Van Miller S,Evans PA,Trivedi MH, Efficacy of porcine secretin in children with autism and pervasive developmental disorder. Journal of autism and developmental disorders. 2002 Jun     [PubMed]
Ozcelebi F,Holtmann MH,Rentsch RU,Rao R,Miller LJ, Agonist-stimulated phosphorylation of the carboxyl-terminal tail of the secretin receptor. Molecular pharmacology. 1995 Nov     [PubMed]
Shetzline MA,Premont RT,Walker JK,Vigna SR,Caron MG, A role for receptor kinases in the regulation of class II G protein-coupled receptors. Phosphorylation and desensitization of the secretin receptor. The Journal of biological chemistry. 1998 Mar 20     [PubMed]
Körner M,Miller LJ, Alternative splicing of pre-mRNA in cancer: focus on G protein-coupled peptide hormone receptors. The American journal of pathology. 2009 Aug     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of NP-Advanced Physiology. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for NP-Advanced Physiology, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in NP-Advanced Physiology, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of NP-Advanced Physiology. When it is time for the NP-Advanced Physiology board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study NP-Advanced Physiology.