成長ホルモンに関する臨床的研究

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It has been established that hypoglycemia stimulates the secretion of human growth hormone (HGH) from the pituitary gland. If the secretion of endogenous insulin from the pancreatic-cells was temporally increased by tolbutamide i.v. injection and hypoglycemia was produced, the serum HGH would be increased as well as the insulin-induced hypoglycemia. In the present study, 1 g tolbutamide was injected i.v. into normal subjects, hyperthyroidism, primary or secondary hypothyroidism, diabetes mellitus and into nephrotic syndromes with or without adrenocortico-steroid hormones in order to know some of the aspects of the mechanism concerning the secretion of HGH from the pituitary gland under hypoglycemia. <BR>In the normal subject, maximum response of serum IRI (Immunoreactive Insulin) was seen within 15 min and the lowest value of blood sugar (50 mg/100 ml) was observed at 30-45 min after the injection of tolbutamide. The serum HGH was clearly increased at 15 min, the highest value of HGH (approximately 15 ng/ml) was achieved 60 min after the I.V. administration of tolbutamide and then the value declined to the fasting level, i.e. around 5 ng/ml. The response-patterns of serum IRI and blood sugar to tolbutamide injection in the patient with hyperthyroidism and primary or secondary hypothyroidism were similar, but HGH showed quite different patterns. Although maximum increase of HGH was slightly lower than that of normal subject, the HGH value was still high even 3 hrs after tolbutamide injection in cases of hyperthyroidism. In primary hypothyroidism, the pattern of response of HGH secretion by the tolbutamide test was clearly impaired, compared with normal subjects. These results suggested that thyroid hormones would be necessary for production and secretion of HGH. No response of HGH was observed in the secondary hypothyroidism after the tolbutamide administration. <BR>As is well known, the tolbutamide test was clinically used for the diagnosis of diabetes mellitus. Decrease of blood sugar level by tolbutamide administration in diabetics contrasted greatly with the normal subject. Because of the difference in the response-pattern of blood sugar in the diabetics from the normal subject, hypoglycemia itself was not a reasonable stress to secrete HGH from the pituitary. However, maximum increase of serum HGH in the diabetics produced by the injection of tolbutamide was only 1/3 of the normal subject, indicating a possible retardation of HGH secretion in the diabetics. <BR>The results from nephrotic syndromes treated with adrenocorticosteroid hormone indicated that the hormone partially blocked the secretion of HGH as reported previously.
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成長ホルモンに関する臨床的研究

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