Federal University of Sergipe, Aracaju, SE, Brazil.
J Clin Endocrinol Metab. 2012 Mar;97(3):1013-9. doi: 10.1210/jc.2011-2590. Epub 2011 Dec 14.
GH reduces insulin sensitivity (IS), whereas IGF-I increases it. IGF-I seems to be critical for the development of the β-cells, and impaired IS has been reported in GH deficiency (GHD).
The aim of the study was to assess IS and β-cell function in adult patients with untreated isolated GHD (IGHD) due to a homozygous mutation in the GHRH receptor gene.
DESIGN, SETTING, AND PATIENTS: We conducted a cross-sectional study in 24 GH-naive adult IGHD subjects and 25 controls.
We performed an oral glucose tolerance test with glucose and insulin measurements at 0, 30, 60, 90, 120, and 180 min.
IS was assessed by homeostasis model assessment index of insulin resistance (IR), quantitative IS check index, oral glucose IS in 2 h (OGIS2) and 3 h (OGIS3). β-Cell function was assayed by homeostasis model assessment index-β, insulinogenic index, and area under the curve of insulin-glucose ratio.
During the oral glucose tolerance test, glucose levels were higher in IGHD subjects (P<0.0001), whereas insulin response presented a trend toward reduction (P=0.08). The number of individuals with impaired glucose tolerance was higher in the IGHD group (P=0.001), whereas the frequency of diabetes was similar in the two groups. Homeostasis model assessment index of IR was lower (P=0.04), and quantitative IS check index and OGIS2 showed a nonsignificant trend toward elevation (P=0.066 and P=0.09, respectively) in IGHD. OGIS3 showed no difference between the groups. Homeostasis model assessment index-β, insulinogenic index, and ratio of the areas of the insulin and glucose curves were reduced in the IGDH group (P=0.015, P<0.0001, and P=0.02, respectively).
Adult subjects with lifetime congenital untreated IGHD present reduced β-cell function, no evidence of IR, and higher frequency of impaired glucose tolerance.
生长激素（GH）降低胰岛素敏感性（IS），而 IGF-1 则增加 IS。IGF-1 似乎对β细胞的发育至关重要，而 GH 缺乏症（GHD）患者的 IS 受损已被报道。
本研究旨在评估由于生长激素释放激素受体基因纯合突变而导致的未经治疗的孤立性 GH 缺乏症（IGHD）成年患者的 IS 和β细胞功能。
设计、地点和患者：我们对 24 名 GH 未治疗的成年 IGHD 患者和 25 名对照进行了横断面研究。
我们进行了口服葡萄糖耐量试验，在 0、30、60、90、120 和 180 分钟时测量血糖和胰岛素。
通过稳态模型评估的胰岛素抵抗指数（IR）、定量 IS 检查指数、2 小时口服葡萄糖 IS（OGIS2）和 3 小时口服葡萄糖 IS（OGIS3）评估 IS。β细胞功能通过稳态模型评估的β指数、胰岛素原指数和胰岛素-葡萄糖比值曲线下面积来测定。
在口服葡萄糖耐量试验中，IGHD 患者的血糖水平更高（P<0.0001），而胰岛素反应呈下降趋势（P=0.08）。IGHD 组糖耐量受损的人数更多（P=0.001），但两组的糖尿病发病率相似。IGHD 组的稳态模型评估的 IR 指数较低（P=0.04），定量 IS 检查指数和 OGIS2 呈升高趋势（P=0.066 和 P=0.09，分别），但 OGIS3 两组之间无差异。IGHD 组的稳态模型评估的β指数、胰岛素原指数和胰岛素-葡萄糖曲线下面积比值均降低（P=0.015、P<0.0001 和 P=0.02，分别）。
终生患有先天性未经治疗的 IGHD 的成年患者表现出β细胞功能降低、无 IR 证据和糖耐量受损的频率增加。
