Summary
Plasma insulin levels have been measured by radio-immunoassay in 15 patients with untreated Cushing's syndrome, using oral glucose tolerance tests (O.G.T.T.), arginine infusions (A.I.) or both of these stimuli. During O.G.T.T., glucose tolerance was impaired in 12 subjects, at the upper limit of the normal range in two, and normal in only one case. Statistically significant hyperinsulinaemia occured in 5 patients. Nine subjects had plasma insulin levels in the control's range, though their glycaemic curve was of the diabetic type. During arginine infusion, insulin peak was not reduced in these 9 patients. A negative response to each test was observed in one patient. These heterogeneous results are discussed in the light of experimental data and known physiological effects of glucocorticoids.
Résumé
L'insulinémie a été étudiée avant tout traitement chez 15 malades atteints d'un syndrome de Cushing lors de la stimulation par le glucose oral, l'arginine intraveineuse ou les deux. Les courbes glycémiques étaient de type diabétique dans 12 cas, à la limite supérieure de la normale chez deux patients et normale dans un seul cas. Cinq de ces sujets seulement ont un hyperinsulinisme statistiquement significatif lors de l'hyperglycémie orale. Neuf ont une insulinémie dans les limites de la normale alors que leurs courbes glycémiques sont diabétiques. Le pic insulinémique lors de l'épreuve à l'arginine n'est pas diminué chez ces derniers. Un malade enfin a une réponse insulinémique très faible au cours des deux épreuves. L'hétérogénéité des troubles de l'insulino-secrétion observée au cours du syndrome de Cushing est discutée à la lumière des données expérimentales et des effets physiologiques connus des glucocorticoïdes.
Zusammenfassung
Bei 15 Cushing-Patienten wurden die Seruminsulinspiegel während einer oralen Glucosebelastung und einer Arginin-Infusion untersucht. 12 der Patienten zeigten eine eingeschränkte, 2 eine leicht gestörte und nur 1 Patient eine normale Glucosetoleranz. 5 Patienten hatten während der oralen Glucosebelastung eine statistisch signifikante Hyperinsulinämie; bei 9 lag die Insulinkonzentration des Blutes innerhalb normaler Grenzen, obgleich sich eine pathologische Blutzuckerkurve fand. Die Maximalwerte der Seruminsulinspiegel unter Arginin-Infusion waren bei diesen 9 Patienten nicht verringert. Bei einem Patienten führten beide Belastungen nur zu einem minimalen Anstieg der Seruminsulinspiegel. Diese heterogenen Befunde zur Insulininkretion beim Cushing-Syndrom werden unter Berücksichtigung experimenteller Befunde und der bekannten physiologischen Effekte der Glucocorticoide besprochen.
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Modigliani, E., Strauch, G., Luton, J.P. et al. Effets du glucose et de l'arginine sur la sécrétion d'insuline au cours des syndromes de Cushing. Diabetologia 6, 8–14 (1970). https://doi.org/10.1007/BF00425885
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DOI: https://doi.org/10.1007/BF00425885