Skip to main content
SpringerLink
Log in

Absence of clinically overt atherosclerotic vascular disease and adverse changes in cardiovascular risk factors in 70 patients with insulinoma

  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Hyperinsulinemia has been assumed to contribute to the pathogenesis of atherosclerosis. To assess the reliability of such claim we planned a retrospective study on a cohort of patients with pancreatic insulin producing neoplasm. A correlation was sought between fasting insulin plasma levels and the metabolic profile emerging from those parameters known to be cardiovascular risk factors, i.e. plasma triglycerides and cholesterol, insulin resistance, hypertension. Special attention was paid to the duration of disease, because the time exposure to hyperinsulinemia could play an important role in developing cardiovascular disease. Seventy patients, 41 females and 29 males, aged 44.9±1.96 yr (range 15–80), with surgically proved insulinoma were included in the study. Chronic exposure to hyperinsulinemia was documented through the measurement of insulin plasma levels either in the fasting state or post-prandially, resulting in 44.7±3.28 and 149.9±12.22 μU/ml, respectively. Fasting glycemia in average was 45.3±1.34 mg/dl. Plasma triglycerides and cholesterol concentrations were 136.3±7.93 and 195.8±5.18 mg/dl, respectively, their distribution overlapping that anticipated for the general population. No correlation arose between the degree of hyperinsulinemia and the lipidic profile. Preoperative blood pressure was 136.9±2.87 mmHg, systolic and 81.9±1.32 mmHg, diastolic. Hypertension was present in 5 (7.1%) out of 70 patients and persisted after tumor removal. A condition of insulin resistance (M=4.06±0.4 mg/kg min vs 7.41±0.21) was documented through the euglycemic hyperinsulinemic clamp technique in 20 patients and showed a positive and significant correlation with fasting insulinemia. In conclusion, these data suggest that insulinomas do not develop an increased risk of cardiovascular disease and we believe that insulin needs the interplay of other factors to manifest its atherogenic potential effect.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stout R.W. Insulin and atheroma. Diabetes Care 13: 631, 1990.

    Article  CAS  PubMed  Google Scholar 

  2. Pyorala K. Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: results from two population studies in Finland. Diabetes Care 2: 131, 1979.

    Article  CAS  PubMed  Google Scholar 

  3. Pyorala K., Savolainen E., Kaukola S., Haapakoski J. High plasma insulin as a coronary heart disease risk factor: relationship to other risk factors and predictive value during 91/2 years follow-up of the Helsinki Policemen Study Population. Acta Med. Scand. (Suppl.) 701: 38, 1985.

    CAS  Google Scholar 

  4. Welborn T.A., Wearne K. Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentration. Diabetes Care 2: 154, 1979.

    Article  CAS  PubMed  Google Scholar 

  5. Fontbonne A., Tchobroutsky G., Eschwege E., Richards J.L., Claude J.R., Rosselin G. Coronary heart disease mortality risk: plasma insulin level is a more sensitive marker than hypertension or abnormal glucose tolerance in overweight males. The Paris prospective study. Int. J. Obesity 12: 557, 1988.

    CAS  Google Scholar 

  6. Fontbonne A., Charles M.A., Thibult N., Richards J.L., Claude J.R., Warnet J.M., Rosselin G.E., Eschwege E. Hyperinsulinemia as a predictor of coronary heart disease mortality in a healthy population: the Paris prospective study, 15-year follow-up. Diabetologia 34: 356, 1991.

    Article  CAS  PubMed  Google Scholar 

  7. Stato Y., Shiraishi S., Oshida Y., Ishiguro T., Sakamoto N. Experimental atherosclerosis-like lesions induced by hyperinsulinism in Wistar rats. Diabetes 38: 91, 1989.

    Article  Google Scholar 

  8. Capron L., Jarnet J., Kazandjian S., Housset E. Growth-promoting effects of diabetes and insulin on arteries. An in vivo study of rat aorta. Diabetes 35: 973, 1986.

    Article  CAS  PubMed  Google Scholar 

  9. Jarrett, R.J. Is insulin atherogenic? Diabetologia 31: 71, 1988.

    Article  CAS  PubMed  Google Scholar 

  10. De Fronzo R.A., Ferrannini E. Insulin resistance: a multi-faceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 14: 173, 1991.

    Article  Google Scholar 

  11. Tamburrano G, Leonetti F., Sbraccia P., Giaccari A., Locuratolo N., Lala A. Increased insulin sensitivity in patients with idiopathic reactive hypoglycemia. J. Clin. Endocrinol. Metab. 69: 885, 1989.

    Article  CAS  PubMed  Google Scholar 

  12. Laurenzi M., Trevisan M. Sodium-lithium countertransport and blood pressure: the Gubbio population study. Hypertension 13: 408, 1989.

    Article  CAS  PubMed  Google Scholar 

  13. The research group ATS-RF2-OB43 of the Italian National Research Council. Time trends of some cardiovascular risk factors in Italy, Results from the nine communities study. Am. J. Epidemiol. 126: 95, 1987.

    Google Scholar 

  14. Progetto Monica”Area Brianza”. Distribuzione dei fattori di rischio coronarico. G. Ital. Cardiol. 18: 1034, 1988.

    Google Scholar 

  15. Nagi D.K., Hendra T.J., Cooper T.M., Temple R.C., Clarke P.M.S., Schneider A.E., Hales C.N., Yudkin J.S. The relationship of concentration of insulin, intact proinsulin and 32–33 split proinsulin with cardiovascular risk factors in type 2 (non insulin dependent) diabetic subjects. Diabetologia 33: 532, 1990.

    Article  CAS  PubMed  Google Scholar 

  16. Tsutsu N., Nunoi K., Kodama T., Nomiyama R., Iwase M., Fijishima M. Lack of association between blood pressure and insulin in patients with insulinoma. J. Hypertension 8: 479, 1990.

    Article  CAS  Google Scholar 

  17. Pontiroli A.E., Alberetto M., Pozza G. Patients with insulinoma show insulin resistance in the absence of arterial hypertension. Letter. Diabetologia 35: 294, 1992.

    Article  CAS  PubMed  Google Scholar 

  18. Sawicki P.T., Heinemann L., Sparke A., Berger M. Hyperinsulinemia is not linked with blood pressure elevation in patients with insulinoma. Diabetologia 35: 649, 1992.

    Article  CAS  PubMed  Google Scholar 

  19. O’Brien T., Young W.F., Palumbo P.J. O’Brien P.C., Service F.J. Is the hyperinsulinemia of insulinoma associated with hypertension and hypertriglyceridemia? Diabetologia 34 (Suppl. 2): A19, 1991.

    Google Scholar 

  20. Welin L., Eriksson H., Larsson B., Ohlson L.Q., Svardsudd K., Tibblin G. Hyperinsulinaemia is not a major coronary risk factor in elderly men. Diabetologia 35: 766, 1992.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. I Cattedra di Endocrinologia, II Clinica Medica, Università La Sapienza, Italy

    F. Leonetti, P. Iozzo, A. Giaccari, P. Sbraccia, G. Tamburrano & D. Andreani

  2. Istituto Superiore di Sanità, Rome, Italy

    A. Buongiorno

Authors
  1. F. Leonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Iozzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Giaccari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Sbraccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Buongiorno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Tamburrano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Andreani
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leonetti, F., Iozzo, P., Giaccari, A. et al. Absence of clinically overt atherosclerotic vascular disease and adverse changes in cardiovascular risk factors in 70 patients with insulinoma. J Endocrinol Invest 16, 875–880 (1993). https://doi.org/10.1007/BF03348949

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03348949

Key-words

Search

Navigation