Insulin Secretion and Insulin Sensitivity Before and After Surgical Treatment of Pheochromocytoma or Paraganglioma
Insulin Secretion and Insulin Sensitivity Before and After Surgical Treatment of Pheochromocytoma or Paraganglioma
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DOI：
10.1210/jc.2017-00357
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发表时间：
2017-09-01
影响因子：
5.8
通讯作者：
Ogawa, Wataru
中科院分区：
文献类型：
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作者：
Komada, Hisako;Hirota, Yushi;Ogawa, Wataru
背景：嗜铬细胞瘤和副神经节瘤是产生儿茶酚胺的肿瘤，通常会损害葡萄糖耐量。然而，这些肿瘤对胰岛素敏感性和胰岛素分泌的影响尚不清楚。目的：为了描述嗜铬细胞瘤或副神经节瘤对糖耐量的影响，我们综合分析了这些肿瘤患者与胰岛素分泌或胰岛素敏感性相关的各种参数。设计：在肿瘤切除前后对患者进行高血糖和高胰岛素-正常血糖钳夹试验以及口服葡萄糖耐量试验（OGTT）。患者在科比大学医院入院时接受代谢分析。患者：11名嗜铬细胞瘤患者和2名副神经节瘤患者接受了检查。干预：无。主要结果测量：我们评估了与胰岛素分泌或胰岛素敏感性相关的各种参数，这些参数由OGTT和高血糖和高胰岛素血症确定。结果：肿瘤手术治疗减少了尿儿茶酚胺排泄，改善了葡萄糖耐量。在OGTT期间以及在高血糖钳夹期间胰岛素分泌的第一时相（但不是第二时相）测量的胰岛素生成指数（但不是总胰岛素分泌）在手术后得到改善。在高胰岛素-正葡萄糖钳夹过程中确定的胰岛素敏感性指数在手术后保持不变。结论：这些结果表明嗜铬细胞瘤和副神经节瘤损害葡萄糖耐量主要是通过损害胰岛素分泌，特别是早期阶段的胰岛素分泌反应。需要更多患者的前瞻性研究来进一步证实这些结果。
Context: Pheochromocytoma and paraganglioma are catecholamine-producing tumors that often impair glucose tolerance. The effects of these tumors on insulin sensitivity and insulin secretion in patients have remained unclear, however.Objective: To characterize the influence of pheochromocytoma or paraganglioma on glucose tolerance, we comprehensively analyzed various parameters related to insulin secretion or insulin sensitivity in patients with these tumors.Design: Hyperglycemic and hyperinsulinemic-euglycemic clamps, as well as an oral glucose tolerance test (OGTT), were performed in patients before and after tumor excision.Setting: Patients underwent metabolic analyses on admission to Kobe University Hospital.Patients: Eleven patients with pheochromocytoma and two with paraganglioma were examined.Intervention: None.Main Outcome Measures: We evaluated various parameters related to insulin secretion or insulin sensitivity as determined by an OGTT and by hyperglycemic and hyperinsulinemic-euglycemic clamp analyses.Results: Surgical treatment of the tumor reduced urinary catecholamine excretion and improved glucose tolerance. The insulinogenic index, but not total insulin secretion, measured during the OGTT as well as the first phase, but not the second phase, of insulin secretion during the hyperglycemic clamp were improved after surgery. The insulin sensitivity index determined during the hyperinsulinemic-euglycemic clamp remained unchanged after surgery.Conclusion: These results suggest pheochromocytoma and paraganglioma impair glucose tolerance primarily through impairment of insulin secretion-in particular, that of the early phase of the insulin secretory response. A prospective study with more patients is warranted to further confirm these results.