Day G, Evans K, Wharton B
Arch Dis Child. 1973 Jan;48(1):41-6. doi: 10.1136/adc.48.1.41.
The effect of intravenous tolbutamide on plasma levels of glucose, cortisol, growth hormone, and insulin, and the effect of oral Bovril on plasma growth hormone have been studied in 10 children with coeliac disease and 6 children who, though small, had normal jejunal morphology (`controls'). The growth hormone and insulin responses to tolbutamide in the children with coeliac disease were significantly smaller than in the controls. Growth hormone response to Bovril was normal in most of the children but 3 of them with coeliac disease failed to achieve a satisfactory response in growth hormone levels after both tolbutamide and Bovril. These results cannot be explained by malnutrition or by inadequate hypoglycaemia during tolbutamide stimulation, and a convincing hypothesis to explain them has not been formulated. Clinically, though tests of other conventional stimuli of growth hormone and insulin production require study, the diagnosis of coeliac disease should actively be considered in any child with low levels of insulin and growth hormone. These observations may partly explain the association of coeliac disease and diabetes mellitus.
在10名患有乳糜泻的儿童和6名虽身材矮小但空肠形态正常的儿童（“对照组”）中，研究了静脉注射甲苯磺丁脲对血浆葡萄糖、皮质醇、生长激素和胰岛素水平的影响，以及口服牛肉汁对血浆生长激素的影响。患有乳糜泻的儿童对甲苯磺丁脲的生长激素和胰岛素反应明显小于对照组。大多数儿童对牛肉汁的生长激素反应正常，但其中3名患有乳糜泻的儿童在注射甲苯磺丁脲和服用牛肉汁后，生长激素水平未能达到满意的反应。这些结果无法用营养不良或甲苯磺丁脲刺激期间低血糖不足来解释，并且尚未形成一个令人信服的假说来解释它们。临床上，虽然其他传统生长激素和胰岛素分泌刺激试验需要研究，但对于任何胰岛素和生长激素水平低的儿童，都应积极考虑乳糜泻的诊断。这些观察结果可能部分解释了乳糜泻与糖尿病之间的关联。
