Vella Adrian, Service F John, O'Brien Peter C
Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
Endocr Pract. 2003 Mar-Apr;9(2):115-8. doi: 10.4158/EP.9.2.115.
To attempt to establish a reference range of glucagon concentrations during hypoglycemia.
We measured glucagon, cortisol, and growth hormone responses in 65 patients with insulinoma and 29 normal control subjects who underwent a 72-hour fast. For comparison, we also assessed these responses in eight patients with noninsulinoma pancreatogenous hypoglycemia syndrome.
At the end of the fasts, median serum cortisol (19.0 mg/dL [range, 3.7 to 44.0] versus 11.0 mg/dL [range, 5.0 to 28.0], respectively; P<0.001) and growth hormone levels (3.5 ng/mL [range, 0.1 to 46.0] versus 1.2 ng/mL [range, 0.1 to 34.0], respectively; P = 0.021) were higher, whereas plasma glucagon (54.5 pg/mL [range, 11.0 to 170.0] versus 75.0 pg/mL [range, 17.0 to 940.0], respectively; P = 0.012) was lower in patients with insulinoma (serum glucose level, 39 mg/dL [range, 14 to 58]) than in control subjects (serum glucose level, 63 mg/dL [range, 47 to 89]). In contrast, the 8 patients with noninsulinoma pancreatogenous hypoglycemia syndrome, a disorder of postprandial hyperinsulinemic hypoglycemia with normal findings on a 72-hour fast (serum glucose level, 71.5 mg/dL [range, 48 to 82]), had concentrations of glucagon (81.0 pg/mL [range, 47.0 to 150.0]), cortisol (10.5 mg/dL [range, 2.7 to 17.0]), and growth hormone (1.5 ng/mL [range, 0.8 to 6.9]) similar to those in the control subjects. On multivariate analysis, the duration of the fast, baseline glucagon concentration, and male gender (but not age, body mass index, or concentrations of glucose and insulin) were correlated with end-of-fast glucagon concentration.
Defective glucagon secretion in hypoglycemic disorders applies to the stimulus of hypoglycemia but not to food deprivation. A conservative estimate for glucagon deficiency based on the minimal observed glucagon response could be a level of 10 pg/mL during hypoglycemia.
试图建立低血糖期间胰高血糖素浓度的参考范围。
我们测量了65例胰岛素瘤患者和29例正常对照者在进行72小时禁食期间的胰高血糖素、皮质醇和生长激素反应。为作比较，我们还评估了8例非胰岛素瘤胰源性低血糖综合征患者的这些反应。
禁食结束时，胰岛素瘤患者（血清葡萄糖水平为39mg/dL[范围14至58]）的血清皮质醇中位数（分别为19.0mg/dL[范围3.7至44.0]与11.0mg/dL[范围5.0至28.0]；P<0.001）和生长激素水平（分别为3.5ng/mL[范围0.1至46.0]与1.2ng/mL[范围0.1至34.0]；P = 0.021）较高，而血浆胰高血糖素（分别为54.5pg/mL[范围11.0至170.0]与75.0pg/mL[范围17.0至940.0]；P = 0.012）较低，低于对照者（血清葡萄糖水平为63mg/dL[范围47至89]）。相比之下，8例非胰岛素瘤胰源性低血糖综合征患者，一种餐后高胰岛素血症性低血糖疾病，72小时禁食时结果正常（血清葡萄糖水平为71.5mg/dL[范围48至82]），其胰高血糖素（81.0pg/mL[范围47.0至150.0]）、皮质醇（10.5mg/dL[范围2.7至17.0]）和生长激素（1.5ng/mL[范围0.8至6.9]）浓度与对照者相似。多变量分析显示，禁食持续时间、基线胰高血糖素浓度和男性性别（而非年龄、体重指数或葡萄糖及胰岛素浓度）与禁食结束时的胰高血糖素浓度相关。
低血糖疾病中胰高血糖素分泌缺陷适用于低血糖刺激，但不适用于食物缺乏。基于观察到的最小胰高血糖素反应对胰高血糖素缺乏的保守估计可能是低血糖期间10pg/mL的水平。
