Growth Hormone Response to Insulin-Induced Hypoglycemia in Diabetes Secondary to Chronic Calcific Pancreatitis

Abstract

Human growth hormone (HGH) responses to insulin-induced hypoglycemia were measured in 6 patients with diabetes secondary to chronic calcific pancreatitis (pancreatic diabetes). A group of carefully matched control • subjects was similarly investigated. Despite induced hypoglycemia of a magnitude not significantly different from the controls at 30 min, and significantly greater at 45 and 60 min, patients with pancreatic diabetes responded with significantly impaired peak HGH levels. The interpretation of these findings is uncertain, although the observation that children with cystic fibrosis of the pancreas show similarly blunted responses suggests that a pancreatic stimulus to HGH secretion may be lacking. (J Clin Endocr 31: 86, 1970) ABNORMAL sensitivity to exogenously ad-JLJL ministered insulin has been demonstrated in patients who develop diabetes secondary to chronic pancreatitis (pancreatic diabetes) (1). Pancreatic glucagon insufficiency may be partly responsible, and preliminary data of Aguilar Parada and associates (2) tend to support this hypothesis. However, as insulin sensitivity can occur in human growth hormone (HGH) deficiency, it was of interest to measure the HGH responses during insulin-induced hypoglycemia in pancreatic diabetes. Materials and MethodsSix lean patients (5 males and 1 female) with well-proven chronic pancreatic disease-all showing radiologically demonstrable pancreatic calcification-were studied. Chronic alcoholism was considered to have been an etiological factor in all cases. Despite this, biochemical evidence of hepatic dysfunction was uniformly absent. No patient was hypoalbuminemic or uremic and there was no known family history of diabetes. The mean age of the patients was 57 yr (range 50-64 yr). All had diabetic glucose tolerance curves (3)-although, except in one instance, the fasting blood sugar was normal. None had previously received insulin therapy (2, taking oral sulfonylurea drugs, were instructed to discontinue them before testing). No patient showed ketosis or admitted to recent heavy consumption of alcohol. None were taking drugs known to suppress the HGH response to insulin hypoglycemia (4, 5).

Growth hormone responses to arginine infusion in patients with chronic pancreatitis: Relationship to glucose intolerance and insulinopenia

“…arginine in our patients with pancreatitis were within the normal range reported by others. This contrasts with a previously reported finding of rather poor HGH responses to insulin hypoglycaemia in 6 pancreatitie patients compared to matched controls [19]. However, in that study peak HGH concentrations were within the accepted range of normal in 5 of the patients [20].…”

The Presence of Retinopathy in Patients with Secondary Diabetes Following Pancreatectomy or Chronic Pancreatitis

“…39 It is difficult to explain why retinopathy in secondary diabetes shows a slow evolution and rarely presents the typical alterations of proliferative retinopathy. A relative hypolipemia 41 or a reduced hGH secretion 42 have been suggested as protective factors against malignant retinopathy. However, our group of secondary diabetic subjects presented normal lipid levels and a normal hGH response to insulin-induced hypoglycemia.…”

Triamcinolone-augmented glucose tolerance in non-diabetic patients with chronic pancreatitis

“…It implies a state of insulin sensitivity in chronic pancreatitis, and this has indeed been demonstrated after exogenous insulin administration (Joffe, Bank and Marks, 1968). Reasons for this are speculative, although decreased secretion of anti-insulin factors, such as growth hormone (Vinik et al, 1970), and pancreatic glucagon (Persson et al, 1971) may be partly responsible.…”