Deranged α-Adrenergic Regulation of Growth Hormone Secretion in Poorly Controlled Diabetes: Reversal of the Exaggerated Response to Clonidine after Continuous Subcutaneous Insulin Infusion
Deranged α-Adrenergic Regulation of Growth Hormone Secretion in Poorly Controlled Diabetes: Reversal of the Exaggerated Response to Clonidine after Continuous Subcutaneous Insulin Infusion
复制标题
控制不佳的糖尿病中生长激素分泌的α-肾上腺素能调节紊乱：连续皮下胰岛素输注后对可乐定的过度反应的逆转
作者：
E. Topper;J. Gertner;S. Amiel;M. Press;M. Genel;W. Tamborlane
摘要：在控制不良的胰岛素依赖型糖尿病中经常观察到血浆生长激素（GH）和外周儿茶酚胺水平升高。由于α肾上腺素能系统在下丘脑调节GH分泌中起着重要作用，我们检验了中枢肾上腺素能活动改变导致糖尿病GH浓度升高的假设。可乐定是一种α-肾上腺素能激动剂，在连续皮下胰岛素泵输注治疗前和治疗1周后，对9例控制不佳的年轻糖尿病患者（年龄12-19岁）进行了给药。正如预期的那样，连续皮下胰岛素输注使平均24小时血糖（从203 ± 21至112 ± 7 mg/dl，p < 0.01）和GH（从17.7 ± 2.1至9.2 ±1.2 ng/ml，p < 0.01）降低至正常对照组的观察值。在糖尿病患者常规治疗期间，血浆GH峰值水平在可乐定后（48.3 ± 8.7 ng/ml）和GH反应曲线下面积增量（3.23 ± 0.58）mgmin/ml，明显高于正常对照组（分别为25.2 ± 2.1 ng/ml，p < 0.05和1.63 ± 0.11 mgmin/ml，p ± 0.0025）。与此相反，生长激素反应可乐定是无法区分的正常后，只有1周的强化胰岛素治疗。我们的研究结果支持糖尿病的代谢控制影响下丘脑对GH分泌的调节的论点，并表明这种改变至少部分与中枢α-肾上腺素能活性的变化有关。
ABSTRACT: Elevated plasma growth hormone (GH) and peripheral catecholamine levels are frequently observed in poorly controlled, insulin-dependent diabetes. Since the alpha adrenergic system plays an important role in hypothalamic regulation of GH secretion, we tested the hypothesis that altered central adrenergic activity contributes to the increased GH concentrations in diabetes. Clonidine, an α-adrenergic agonist, was administered to nine poorly controlled, young diabetic patients (age 12–19 yr) before and after 1 wk of continuous subcutaneous insulin infusion pump therapy. As expected, continuous subcutaneous insulin infusion lowered mean 24-h plasma glucose (from 203 ± 21 to 112 ± 7 mg/dl,p < 0.01) and GH (from 17.7 ± 2.1 to 9.2 ±1.2 ng/ml, p < 0.01) to values observed in normal controls. In the diabetic patients during conventional treatment, both the peak plasma GH level postclon-idine (48.3 ± 8.7 ng/ml) and the incremental area under the GH response curve (3.23 ± 0.58 mgmin/ml) were significantly increased above normal control values (25.2 ± 2.1 ng/ml, p < 0.05 and 1.63 ± 0.11 mgmin/ml, p ± 0.0025, respectively). In contrast, the GH response to clonidine was indistinguishable from normal after only 1 wk of intensified insulin treatment. Our findings support the contention that metabolic control of diabetes influences hypothalamic regulation of GH secretion and suggests that such alterations are related, at least in part, to changes in central α-adrenergic activity.
生长激素水平升高在调节糖尿病代谢紊乱中的重要性。
DOI：
10.1056/nejm198403293101302
发表时间：
1984
期刊：
The New England journal of medicine
影响因子：
--
作者：
Press,M;Tamborlane,WV;Sherwin,RS
通讯作者：
Sherwin,RS
尽管胰腺切除术后糖尿病患者缺乏生长激素，但仍会出现糖尿病并发症。
DOI：
10.1056/nejm198403293101307
发表时间：
1984
期刊：
The New England journal of medicine
影响因子：
--
作者：
Rabin,D;Bloomgarden,ZT;Feman,SS;Davis,TQ
通讯作者：
Davis,TQ