Abstract
Background
Leprechaunism is a rare congenital syndrome and the most severe form of insulin resistance syndrome, with mutations in the insulin receptor gene. Recombinant human insulin-like growth factor-1 (rhIGF-1) is currently applicable to the treatment for insulin resistance syndrome by its insulin-like effect. Although IGF-1 is thought to promote tissue proliferation and neovascularization, it is uncertain how it acts on the development of diabetic retinopathy.
Methods
Interventional case report.
Results
A 12-year-old girl with leprechaunism has been treated with IGF-1 since she was 6 months old. She presented with neovascular glaucoma in the left eye, but with no serious changes in the right fundus except for tortuosity and dilatation of retinal veins. Thereafter, retinal neovascularization in the right eye developed in 6 months to form a loop-shaped vascular network in the vitreous cavity despite panretinal photocoagulation.
Conclusions
Characteristics of retinal neovascularization and clinical course suggest that IGF-1 treatment was closely associated with the development of diabetic retinopathy in this case.
Similar content being viewed by others
References
Chantelau E (1998) Evidence that upregulation of serum IGF-1 concentration can trigger acceleration of diabetic retinopathy. Br J Ophthalmol 82:725–730
Grant MB, Mames RN, Fitzgerald C, Ellis EA, Aboufriekha M, Guy J (1993) Insulin-like growth factor I acts as an angiogenic agent in rabbit cornea and retina: comparative studies with basic fibroblast growth factor. Diabetologia 36:282–291
Kadowaki T, Bevins CL, Cama A, Ojamaa K, Marcus-Samuels B, Kadowaki H, Beitz L, MoKeon C, Taylor SI (1988) Two mutant alleles of the insulin receptor gene in a patient with extreme insulin resistance. Science 240:787–790
Kondo T, Vicent D, Suzuma K, Yanagisawa M, King GL, Holtzenberger M, Kahn CR (2003) Knockout of insulin and IGF-1 receptors on vascular endothelial cells protects against retinal neovascularization. J Clin Invest 111:1835–1842
Kosztolanyi G (1997) Leprechaunism/Donohue syndrome/insulin receptor gene mutations: a syndrome delineation story from clinicopathological description to molecular understanding. Eur J Pediatr 156:253–255
Kuzuya H (1994) Long-term effects of insulin-like growth factor I (IGF-I) on insulin resistant diabetes. Clin Pediatr Endocrinol 3:127–133
Martin XD, Zenobi PD (2001) Type a syndrome of insulin resistance: anterior chamber anomalies of the eye and effects of insulin-like growth factor-I on the retina. Ophthalmologica 215:117–123
Nakae J, Kato M, Murashita M, Shinohara N, Tajima T, Fujieda K (1998) Long-term effect of recombinant human insulin-like growth factor I on metabolic and growth control in a patient with leprechaunism. J Clin Endocrinol Metab 83:542–549
Olsen BS, Sjolie AK, Hougaard P, Johannesen J, Marinelli K, Jacobsen BB, Mortensen HB, Danish Study Group of Diabetes in Childhood (2004) The significance of the prepubertal diabetes duration for the development of retinopathy and nephropathy in patients with type 1 diabetes. J Diabetes Complications 18:160–164
Schoenle EJ, Zenobi PD, Torresani T, Werder EA, Zachmann M, Froesch ER (1991) Recombinant human insulin-like growth factor I (rhIGF-I) reduces hyperglycaemia in patients with extreme insulin resistance. Diabetologia 34:675–679
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kitamei, H., Yokoi, M., Kase, M. et al. Retinal neovascularization during treatment with IGF-1 for insulin resistance syndrome. Graefe's Arch Clin Exp Ophthalmol 243, 715–717 (2005). https://doi.org/10.1007/s00417-004-1093-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-004-1093-6