Natural course of growth hormone hypersecretion in insulin-dependent diabetes mellitus

Würzburger, M. I.; Sönksen, Peter H.

doi:10.1016/s0306-9877(96)90015-8

Cited by 21 publications

(15 citation statements)

References 53 publications

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“…In man, circulating IGF-I is considered to be produced mainly by the liver (1). Even when the peripheral plasma concentrations of insulin are close to the normal range, the intraportal liver concentrations are considerably less than physiological concentrations (22,23). Indeed intraperitoneal or intraportal insulin delivery has been found to be more effective than subcutaneous infusion of insulin to increase plasma IGF-I concentrations in adult patients with type 1 diabetes, indicating that portal insulin concentrations are of importance for circulating IGF-I concentrations in patients with this condition (18,20).…”

Section: Introductionmentioning

confidence: 99%

Circulating IGF-I concentrations are low and not correlated to glycaemic control in adults with type 1 diabetes

Ekman¹,

Nyström²,

Arnqvist

2000

European Journal of Endocrinology

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Objective: To study plasma concentrations of insulin-like growth factor-I (IGF-I) in adults with type 1 diabetes (IDDM) in comparison with a reference population, and the in¯uence of glycaemic control, dose of insulin, and sex on the concentration of circulating IGF-I in IDDM. Design and methods: Patients with type 1 diabetes were recruited consecutively from our outpatient diabetes unit. In all, 79 men and 55 women aged 20±60 years with a disease duration $6 years (range 6±51 years) took part in the study. A reference population of 80 men and 83 women aged 20±60 years was randomly obtained from the population registry. IGF-I was measured with radioimmunoassay after acid±ethanol extraction.

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Section: Introductionmentioning

confidence: 99%

Circulating IGF-I concentrations are low and not correlated to glycaemic control in adults with type 1 diabetes

Ekman¹,

Nyström²,

Arnqvist

2000

European Journal of Endocrinology

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“…Age-and gendermatched serum IGF-1 are elevated in acromegaly and an IGF-1 level provides a useful laboratory screening measure when clinical features raise the possibility of acromegaly [1]. In insulin-dependent diabetes, however, GH/IGF-1 axis could be disturbed due to decreased insulin, which is necessarily needed to produce IGF-1 in hepatocytes [4][5][6]. In addition, from a previous study insulin-dependent diabetic patients had elevated GH concentrations and inappropriately normal IGF-1 levels [7].…”

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confidence: 99%

Acromegaly Associated with Type 2 Diabetes Showing Normal IGF-1 Levels under Poorly Controlled Glycemia

et al. 2007

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Abstract. Acromegaly is caused by excessive secretion of growth hormone (GH), and a resultant persistent elevation of insulin-like growth factor-1 (IGF-1) levels. Diabetes mellitus is accompanied in some acromegalic patients with insulin resistance. We encountered a type-2 diabetic patient who had a poorly controlled glycemic state and was diagnosed as acromegaly with normal IGF-1 levels. The patient showed definite acromegalic features. However, in the first screening test, GH levels were high and IGF-1 levels were inappropriately normal so the results were not close to the diagnosis of acromegaly. After moderate glycemic control, an oral glucose suppression test was performed, showing no suppressed GH response. TRH test revealed paradoxical increases in growth hormone levels and a brain MRI discovered a pituitary adenoma. After several-months insulin treatment, IGF-1 levels were increased to the abnormal state and GH levels were decreased without treatment for acromegaly. Here we report the rare case of acromegaly that presents inappropriately normal IGF-1 levels at the time of diagnosis in uncontrolled type 2 diabetic patient and shows increased IGF-1 levels after glycemic control with insulin therapy. When evaluating acromegaly in type 2 diabetes under poorly controlled glycemia, cautious IGF-1 analysis is needed after sufficient glycemic control.

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“…As insulin induces the expression of GH receptors on hepatocytes, which are the major sites of IGF-1 production, poorly controlled diabetes with a lack of insulin action leads to a state of hepatic GH resistance. Consequently, b-cell dysfunction causes blood GH levels to elevate and blood IGF-1 levels to lower or normalize [9]. Thus, high blood GH levels do not always mean acromegaly.…”

Section: Discussionmentioning

confidence: 99%

“…The measurement of serum IGF-1 and IGF-binding protein-3 (IGFBP-3) has been reported as being valuable for the diagnosis of acromegaly in type 1 diabetes [7,8]. However, it may be sometimes difficult to diagnose acromegaly associated with type 1 diabetes because insulin, GH and IGF-1 may mutually interfere with each other on secretion [9].…”

mentioning

confidence: 99%

Type 1 Diabetes Associated with Asymptomatic Acromegaly Successfully Treated with Surgery after Pregnancy: A Case Report

Iwai

Ito

et al. 2005

Endocr J

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Abstract. We report a rare case of type 1 diabetes in a woman associated with acromegaly who was treated with surgery after pregnancy. An 18-year-old woman came to our hospital in April, 1998, complaining of thirst, polydipsia, polyuria, appetite loss, body weight loss of 8 kg in a month, and amenorrhea beginning 2 months earlier. Based on laboratory data, she was diagnosed as having type 1 diabetes mellitus. Although we suspected her of having acromegaly because of high growth hormone (GH) levels (6.9 or 8.5 ng/ml), blood levels of insulin-like growth factor 1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) were within normal range and the circadian rhythm of her blood GH levels was normally maintained. Her blood GH level was elevated to 12.6 ng/ml 15 minutes after a TRH administration. Blood GH levels were suppressed from 49 ng/ml to 1.5 ng/ml 4 hours after an oral administration of 2.5 mg of bromocriptine. A magnetic resonance images (MRIs) showed pituitary swelling, but no nodules were found in the pituitary. Therefore, we diagnosed her as having acromegaly and observed her without surgery, while prescribing diet therapy and intensive insulin therapy for diabetes. We started a treatment of oral administration of 7.5 mg of bromocriptine per day for the acromegaly from April 28, 2000, because her elevated GH was suspected of causing her diabetes to be poorly controlled. During a pregnancy from October, 2000 to September, 2001, diabetic control was improved with increased administration of insulin under a constant dose of bromocriptine. She delivered a normal full-term infant. After the bromocriptine therapy was stopped as she hoped to breastfeed, blood levels of GH and IGF-1 became elevated and her diabetic control deteriorated. As her pituitary tumor observed in pituitary MRIs became larger during the course, a transsphenoidal surgery was performed on March 8, 2002. After the surgery, blood levels of GH and IGF-1 lowered and diabetic control improved again. We concluded as follows: to rule out acromegaly in patients with poorly controlled diabetes, 1) measurements of serum GH and IGF-1 should be performed, and 2) pituitary MRIs should be performed if blood levels of GH or IGF-1 are high.

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Natural course of growth hormone hypersecretion in insulin-dependent diabetes mellitus

Cited by 21 publications

References 53 publications

Circulating IGF-I concentrations are low and not correlated to glycaemic control in adults with type 1 diabetes

Circulating IGF-I concentrations are low and not correlated to glycaemic control in adults with type 1 diabetes

Acromegaly Associated with Type 2 Diabetes Showing Normal IGF-1 Levels under Poorly Controlled Glycemia

Type 1 Diabetes Associated with Asymptomatic Acromegaly Successfully Treated with Surgery after Pregnancy: A Case Report

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