ACTH単独欠損症患者におけるglucoseおよびarginine負荷時の血中insnlin反応について

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It is generally accepted that plasma insulin levels (IRI) are low in patients with isolated ACTH deficiency. But, a comparison of IRI levels before and after replacement therapy has not yet been reported. We studied the insulin response to glucose and arginine administration (O-GTT, ATT) in 4 cases whom we encountered during the last 4 years. In O-GTT, 50g of glucose was given. In ATT, after 0.5g/kg arginine was infused intravenously, blood specimens were drawn at 0, 5, 15, 30, 60, 90,120 and 180 minutes. Plasma insulin was determined by a double antibody radioimmunoassay, and glucose (BS) was determined by an autoanalyser.<BR>The results were as follows : <BR>O-GTT : Before replacement therapy using glucocorticoid, in all 3 cases in whom the test was done, BS curves showed a normal pattern. Fasting plasma IRI levels and ∑IRI were low in 2 cases (cases 1 and 3). In the other one (case 4), plasma IRI levels at fasting, 120 and 180 minutes were undetectable. However, the peak IRI level at 60 minutes was very high (269uU/ml). One month after the initiation of replacement therapy ∑Bs increased in all cases. Fasting IRI, peak IRI levels and ∑IRI also increased in 2 cases (cases 1 and 3). In case 4, although fasting IRI increased, peak IRI level and ∑IRI markedly decreased.<BR>ATT : Before replacement therapy, BS curves showed low responses in all 4 cases. Plasma IRI peaks were observed at 5 minutes in all cases, and they showed low or low normal. During therapy, BS peak levels and plasma IRI peak levels increased in all cases, especially in case 4.<BR>From the above results, the insulin response to O-GTT and ATT in patients with isolated ACTH deficiency were divided into 2 groups. One showed concordance with the results in O-GTT and ATT before and after replacement therapy. The other showed dissociation from the results in O-GTT and NIT before and after replacement therapy. It was supposed that the differences in insulin response might be caused by a localization of the lesions in the brain.
日本内分泌学会の論文

ACTH単独欠損症患者におけるglucoseおよびarginine負荷時の血中insnlin反応について

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