Ferrannini E, Muggeo M, Navalesi R, Pilo A
Am J Med. 1982 Jul;73(1):148-54. doi: 10.1016/0002-9343(82)90942-1.
The kinetics of plasma insulin were studied in a 14 year old girl with the syndrome of insulin resistance and acanthosis nigricans. The clearance of plasma insulin was found to be strikingly reduced (135 ml/min . m2 versus 456 +/- 22 in 17 normal control subjects), whereas the basal systemic insulin delivery rate was increased about 10-fold (25.5 mU/min . m2 versus 2.6 +/- 0.3 in normal subjects). Thus, reduced insulin clearance and excessive posthepatic delivery of the hormone both contributed to the severe fasting hyperinsulinemia (218 microunits/ml) associated with the other clinical features of the syndrome (glucose intolerance, primary amenorrhea, polycystic ovaries, hirsutism). Following ovarian wedge resection, insulin clearance rose to 264 ml/min . m2, and insulin delivery fell to 9.8 microunits/ml min . m2. The resulting abatement of the patient's hyperinsulinism (fasting plasma insulin = 37 microunits/ml) was accompanied by the appearance of menses, normalization of glucose tolerance, and amelioration of the acanthosis. The improvement in menstrual function and acanthosis, however, was not sustained. This case provides evidence for interdependence of insulin action and insulin degradation in humans.
对一名患有胰岛素抵抗综合征和黑棘皮病的14岁女孩的血浆胰岛素动力学进行了研究。发现该女孩血浆胰岛素清除率显著降低（135 ml/min·m²，而17名正常对照受试者为456±22），而基础全身胰岛素输送率增加了约10倍（25.5 mU/min·m²，正常受试者为2.6±0.3）。因此，胰岛素清除率降低和肝脏后激素过度输送均导致了与该综合征其他临床特征（葡萄糖耐量异常、原发性闭经、多囊卵巢、多毛症）相关的严重空腹高胰岛素血症（218微单位/ml）。卵巢楔形切除术后，胰岛素清除率升至264 ml/min·m²，胰岛素输送降至9.8微单位/ml·min·m²。患者高胰岛素血症的减轻（空腹血浆胰岛素 = 37微单位/ml）伴随着月经来潮、葡萄糖耐量正常化和黑棘皮病改善。然而，月经功能和黑棘皮病的改善并未持续。该病例为人类胰岛素作用与胰岛素降解的相互依存提供了证据。
