Fischer Micah A, Elmahmudi Ghada A, Goldsweig Bracha K, Elrokhsi Salaheddin H
Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, Nebraska, USA.
Department of Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Endocrinol Diabetes Metab Case Rep. 2023 May 16;2023(2). doi: 10.1530/EDM-22-0276. Print 2023 May 1.
Multiple research studies address the anti-insulinemic effect of growth hormone (GH). We report a case of a patient with anterior hypopituitarism on GH replacement who later developed type 1 diabetes mellitus (T1DM). Recombinant human growth hormone (rhGH) therapy was discontinued at the time of growth completion. Because of significantly improved glycemic control, this patient was weaned off subcutaneous insulin. He regressed from stage 3 to stage 2 T1DM and remained in this status for at least 2 years and until the writing of this paper. The diagnosis of T1DM was established based on relatively low C-peptide and insulin levels for the degree of hyperglycemia as well as seropositivity of zinc transporter antibody and islet antigen-2 antibody. Additional laboratory data obtained 2 months after discontinuing rhGH revealed improved endogenous insulin secretion. This case report calls attention to the diabetogenic effect of GH therapy in the setting of T1DM. It also demonstrates the possibility of regression from stage 3 T1DM requiring insulin therapy to stage 2 T1DM with asymptomatic dysglycemia after discontinuing rhGH.
Given the diabetogenic effect of growth hormone, blood glucose levels should be monitored in patients with type 1 diabetes mellitus (T1DM) on insulin therapy and recombinant human growth hormone (rhGH) replacement. Clinicians should closely monitor for risk of hypoglycemia after discontinuing rhGH among T1DM patients who are on insulin treatment. The discontinuation of rhGH in the setting of T1DM may cause regression of symptomatic T1DM to asymptomatic dysglycemia requiring no insulin treatment.
多项研究探讨了生长激素（GH）的抗胰岛素作用。我们报告了1例垂体前叶功能减退患者在接受GH替代治疗后发生1型糖尿病（T1DM）的病例。重组人生长激素（rhGH）治疗在生长结束时停止。由于血糖控制显著改善，该患者停用了皮下胰岛素。他从3期T1DM退回到2期，并至少维持了2年这一状态，直至撰写本文时。T1DM的诊断基于相对较低的C肽和胰岛素水平（相对于高血糖程度）以及锌转运体抗体和胰岛抗原2抗体的血清学阳性。停用rhGH 2个月后获得的其他实验室数据显示内源性胰岛素分泌有所改善。本病例报告提醒人们注意GH治疗在T1DM背景下的致糖尿病作用。它还证明了在停用rhGH后，3期需要胰岛素治疗的T1DM有可能退回到2期无症状血糖异常状态。
鉴于生长激素的致糖尿病作用，对于接受胰岛素治疗和重组人生长激素（rhGH）替代治疗的1型糖尿病（T1DM）患者，应监测其血糖水平。临床医生应密切监测接受胰岛素治疗的T1DM患者停用rhGH后发生低血糖的风险。在T1DM患者中停用rhGH可能会使有症状的T1DM退回到无需胰岛素治疗的无症状血糖异常状态。
