Insulin resistance due to a defect distal to the insulin receptor: Demonstration in a patient with leprechaunism
| Autor: | James A. Horner, Masashi Kobayashi, Fiser Rh, B D Given, Arthur H. Rubenstein, Joycelyn M. Elders, Raymond L. Hintz, Jerrold M. Olefsky, Heinrich K. Schedwie, Mary E. Mako |
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| Rok vydání: | 1978 |
| Předmět: |
Blood Glucose
medicine.medical_specialty medicine.medical_treatment Disorders of Sex Development Deoxyglucose Biology Glucagon Insulin resistance Internal medicine medicine Hyperinsulinemia Humans Insulin Autoantibodies Biological Sciences: Medical Sciences Multidisciplinary Infant Biological Transport Syndrome medicine.disease Receptor Insulin Insulin oscillation Insulin receptor Endocrinology Basal (medicine) biology.protein Female Donohue syndrome Insulin Resistance |
| Zdroj: | Proceedings of the National Academy of Sciences. 75:3469-3473 |
| ISSN: | 1091-6490 0027-8424 |
| DOI: | 10.1073/pnas.75.7.3469 |
| Popis: | We have studied a 2-year-old girl with acanthosis nigricans, glucose intolerance, marked hyperinsulinemia, and somatic features characteristic of the leprechaunism syndrome. Circulating plasma insulin levels were increased up to 50-fold and the patient showed a blunted hypoglycemic response to an injection of exogenous insulin (0.2 units/kg), indicating the presence of severe insulin resistance. Insulin purified from the patient's plasma was normal on the basis of chromatographic, electrophoretic, and immunologic criteria. Furthermore, the purified insulin competed effectively with 125 I-labeled insulin for binding to insulin receptors on cultured IM-9 lymphocytes and rat fat cells and also exhibited normal biological potency when tested on rat fat cells. Anti-insulin receptor and anti-insulin antibodies were not detected in the patient's plasma, and plasma levels of glucagon, growth hormone, and cortisol were normal. Insulin binding to the patient's circulating monuclear leukocytes was only slightly depressed into the low normal range and could not account for the severe insulin resistance. Studies on the patient's fibroblasts revealed normal levels of insulin receptors but a total absence of insulin's ability to accelerate glucose transport. Because rates of glucose transport and metabolism were normal in the basal state in the absence of insulin, we conclude that this patient's insulin resistance is due to an inherited cellular defect in the coupling mechanism between occupied insulin receptors and the plasma membrane glucose transport system. |
| Databáze: | OpenAIRE |
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