Jørgensen Jens O L, Krag Morten, Jessen Niels, Nørrelund Helene, Vestergaard Esben T, Møller Niels, Christiansen Jens S
Medical Department M (Endocrinology and Diabetes) and Institute of Experimental Clinical Research, Arhus University Hospital, Arhus, Denmark.
Horm Res. 2004;62 Suppl 3:51-5. doi: 10.1159/000080499.
Patients with active acromegaly are insulin-resistant and glucose-intolerant, whereas children with growth hormone (GH) deficiency (GHD) are insulin-sensitive and may develop fasting hypoglycaemia. Surprisingly, however, hypopituitary adults with unsubstituted GHD tend to be insulin-resistant, which may worsen during GH substitution. During fasting, which may be considered the natural domain for the metabolic effects of GH, the induction of insulin resistance by GH is associated with enhanced lipid oxidation and protein conservation. In this particular context, insulin resistance appears to constitute a favourable metabolic adaptation. The problem is that GH substitution results in elevated circadian GH levels in non-fasting patients. The best way to address this challenge is to employ evening administration of GH and to tailor the dose. Insulin therapy may cause hypoglycaemia and GH substitution may cause hyperglycaemia. Such untoward effects should be minimized by carefully monitoring the individual patient.
患有活动性肢端肥大症的患者存在胰岛素抵抗和葡萄糖不耐受，而生长激素（GH）缺乏症（GHD）患儿则对胰岛素敏感，且可能出现空腹低血糖。然而，令人惊讶的是，未接受替代治疗的垂体功能减退成年患者往往存在胰岛素抵抗，在进行GH替代治疗时这种情况可能会恶化。在禁食期间，这可被视为GH发挥代谢作用的自然状态，GH诱导的胰岛素抵抗与脂质氧化增强和蛋白质保存有关。在这种特定情况下，胰岛素抵抗似乎构成一种有利的代谢适应。问题在于，GH替代治疗会使非禁食患者的昼夜GH水平升高。应对这一挑战的最佳方法是在晚上给予GH并调整剂量。胰岛素治疗可能导致低血糖，而GH替代治疗可能导致高血糖。应通过仔细监测个体患者将此类不良影响降至最低。
