Kousta E, Chrisoulidou A, Lawrence N J, Anyaoku V, Al-Shoumer K A, Johnston D G
Section of Endocrinology and Metabolic Medicine, Imperial College School of Medicine, St Mary's Hospital, London, UK.
Clin Endocrinol (Oxf). 2000 Jan;52(1):17-24. doi: 10.1046/j.1365-2265.2000.00862.x.
Hypopituitary adults on conventional replacement have low concentrations of metabolic fuels throughout the night, possibly related to GH deficiency or to decreased cortisol levels overnight. We investigated whether GH replacement corrects the overnight fuel deficiency.
We measured circulating levels of metabolic fuels: glucose, non-esterified fatty acids (NEFA), glycerol and 3-hydroxybutyrate (3-OHB) and insulin concentrations over 24 h (from 0730 h to 0700 h) in hypopituitary adults before and after GH treatment in a randomized double-blind placebo-controlled trial of 3 months' duration.
Thirteen hypopituitary patients, 8 women and 5 men, were studied.
Six patients (4 women and 2 men) received GH and 7 patients (4 women and 3 men) were allocated to receive placebo. There was no difference in fasting (0730 h), area under the curve (AUC) between 2400 h and 0700 h (overnight) and AUC over 24 h for plasma glucose, 3-OHB, glycerol and insulin concentrations as a result of GH treatment. Fasting and overnight AUC for NEFA were significantly higher on GH treatment ((mean +/- SEM) 243 +/- 29 vs. 446 +/- 90 micromol/l, P = 0.03, 1522 +/- 208 vs. 2167 +/- 123 micromol/l H, P = 0.046, respectively), but AUC over 24 h was not affected significantly. No significant changes in any fuel were seen in the placebo group. The changes in fasting, overnight and 24 h AUC for glucose, 3-OHB, glycerol and insulin levels with GH and with placebo for 3 months were similar. The changes in fasting and overnight AUC for NEFA before and after 3 months were significantly different in the group treated with GH vs. the group treated with placebo (median (lower-upper quartile) 104 (90-276) vs. -89 (-98 to 26) micromol/l, P = 0.002; 633 (263-967) vs. -895 (-1379 to -494) micromol/l h, P = 0.002, respectively), but the changes in 24-h AUC for NEFA were not significant between the two groups.
GH replacement in hypopituitary adults increases fasting and overnight (between 2400 h and 0700 h) non-esterified fatty acid concentrations, consistent with the known lipolytic effect of GH. GH did not influence the concentrations of other metabolic fuels or insulin.
接受传统替代治疗的垂体功能减退成年患者在夜间代谢燃料浓度较低，这可能与生长激素缺乏或夜间皮质醇水平降低有关。我们研究了生长激素替代治疗是否能纠正夜间燃料缺乏。
在一项为期3个月的随机双盲安慰剂对照试验中，我们测量了垂体功能减退成年患者在生长激素治疗前后24小时（从07:30至07:00）循环代谢燃料水平：葡萄糖、非酯化脂肪酸（NEFA）、甘油和3-羟基丁酸（3-OHB）以及胰岛素浓度。
研究了13例垂体功能减退患者，其中8例女性和5例男性。
6例患者（4例女性和2例男性）接受生长激素治疗，7例患者（4例女性和3例男性）被分配接受安慰剂治疗。生长激素治疗后，空腹（07:30）、24:00至07:00（夜间）曲线下面积（AUC）以及24小时血浆葡萄糖、3-OHB、甘油和胰岛素浓度的AUC均无差异。生长激素治疗后，空腹和夜间NEFA的AUC显著升高（（均值±标准误）分别为243±29 vs. 446±90 μmol/L，P = 0.03；1522±208 vs. 2167±123 μmol/L·h，P = 0. )
垂体功能减退成年患者接受生长激素替代治疗可提高空腹和夜间（24:00至07:00）非酯化脂肪酸浓度，这与生长激素已知的脂解作用一致。生长激素不影响其他代谢燃料或胰岛素的浓度。
