Studies of Immunoreative Insulin in a Patient with Lipoatrophic Diabetes
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概要
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A case of lipoatrohic diabetes was reported with special reference to a plasma immunoreactive insulin (IRI) response to several stimulations.<BR>The patient was a Japanese female, twenty five years of age, who had been noted to have no subcutaneous fat since the birth, and was found to have glucosuria at the age of twenty four. Physical examination showed prominant musculature with marked general lipodystrophy, acanthosis nigricans, hepatomegaly, peripheral neuropathy and diabetic retinopathy. Routine laboratory findings were normal except for glucosuria without ketonuria, and an abnormal glucose tolerance test (GTT). Serum lipid and BMR were normal on admission, and increased to abnormal levels thereafter.<BR>To search for the cause of insulin resistance which was detected by the insulin tolerance test, insulin antagonist, insulin antibody and insulin as well as growth hormone response to several stimulations were studied. IRI response to oral GTT and intravenous injection of tolbutamide was high, but the glucose level was not decreased. Gelfiltration of plasma IRI was performed using Sephadex G-50, and a normal elution pattern was detected without any increase of higher molecular weight insulin. The insulin antagonist in urine, extracted according to Louis method, was negative. The plasma growth hormone level, stimulated by glucose, insulin, arginine and leucine, was not high. Insulin resistance was noted not only to endogenous, but also exogenous insulin, but there was no evidence of increase of insulin antibody (titer) in serum. Thus the only possible explanation for the insulin resistance in our patient was the total absence of adipose tissue as a target organ to be affected by insulin.<BR>Then, insulin response was studied after treatment with chlorpropamide. Her fasting IRI level increased to as high a level as 80μU/m<I>l</I> after treatment with chlorpropamide, and IRI response to oral GTT was extremely high compared with the one before the treatment. But response to intravenous admnistration of tolbutamide did not change, suggesting that glucose and tolbutamide stimulate different points to secret insulin.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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