ABSTRACT
Patients with adult GH deficiency (AGHD) have a high cardiovascular risk and probably an alteration of the oxidative balance, although evidence is lacking. To evaluate the presence of endothelial dysfunction and oxidative stress in patients with AGHD. Biochemical parameters of oxidative stress and endothelial dysfunction were compared in 25 patients with previously untreated AGHD and 25 healthy controls matched by age and sex. Multivariate analysis was performed to identify independent predictors of oxidative stress. Vascular function of subcutaneous resistance arteries was also analyzed by means of wire myography in 7 patients with untreated AGHD and in 7 healthy controls with similar characteristics. The values of C-reactive protein, interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α), were higher in the AGHD group (4.6 vs. 0.2 µg/L, P = 0.02; 5.6 vs. 1.2 pg/mL, P = 0.001; 6.7 vs. 2.1 pg/mL, P = 0.04; respectively). The levels of type-1 vascular cell adhesion molecule, total anti-oxidant state, oxidized LDL (LDL-ox) were also greater in AGHD patients (678 vs. 423 ng/mL, P = 0.004; 1235.6 vs. 1002.3 µmol/L, P = 0.01; 172.2.5 vs. 42.3 ng/mL, P = 0.02; respectively). Nitric oxide (NO), reduced glutathione (GSH) and reduced/oxidized glutathione ratio (GSH/GSSG) values were lower than controls (18.7 vs. 31.6 mmol/mg protein, P = 0.01; 372.2 vs. 756.2 µmol/L, P = 0.03; 17.2 vs. 38.4, P = 0.04; respectively). Multiple regression analysis showed that AGHD was an independent predictor of increased LDL-ox (P = 0.002) and decreased GSH (P = 0.000). Furthermore, the degree of vascular relaxation to repeated exposure of acetylcholine was lower in AGHD (P = 0.025). Patients with AGHD have an increased degree of oxidative stress and endothelial dysfunction that could already be present in early stages of the disease. Studies with a greater number of patients are needed in order to confirm our findings.
Subject(s)
Human Growth Hormone/deficiency , Hypopituitarism/metabolism , Oxidative Stress/physiology , Adult , C-Reactive Protein/metabolism , Cross-Sectional Studies , Female , Free Radicals/metabolism , Glutathione/metabolism , Glutathione Disulfide/metabolism , Humans , Hypopituitarism/physiopathology , Interleukin-6/metabolism , Male , Middle Aged , Multiple Sclerosis , Nitric Oxide/metabolism , Tumor Necrosis Factor-alpha/metabolism , Young AdultSubject(s)
Adrenal Gland Neoplasms/diagnosis , Hemangioma, Cavernous/diagnosis , Magnetic Resonance Imaging , Adrenal Gland Neoplasms/pathology , Adrenal Gland Neoplasms/surgery , Adrenalectomy , Aged , Carcinoma/diagnosis , Comorbidity , Diagnosis, Differential , Hemangioma, Cavernous/pathology , Hemangioma, Cavernous/surgery , Humans , Male , Pheochromocytoma/diagnosisABSTRACT
Las alteraciones hepáticas en la diabetes pueden ser muy diversas; la más frecuente es la enfermedad de hígado graso no alcohólico. La glucogenosis hepática adquirida es un cuadro caracterizado por acumulación de glucógeno intrahepatocitaria en la diabetes mellitus tipo 1 mal controlada y en tratamiento con altas dosis de insulina. Se presenta el caso de un adolescente diabético con una elevación progresiva de fermentos hepáticos junto con mal control metabólico. Tras descartar otras causas de hepatopatía, se llegó al diagnóstico clínico de glucogenosis hepática secundaria por la recuperación de los parámetros tras la mejoría del control glucémico sin necesidad de realizar biopsia hepática. La glucogenosis hepática secundaria es un proceso quizá más frecuente de lo publicado, reversible y con buena evolución en función del control metabólico. El diagnóstico puede ser clínico y la biopsia hepática debería reservarse a los pacientes sin mejoría tras alcanzar un mejor control glucémico (AU)
There are several manifestations of hepatic involvement in diabetes but the most frequent is non-alcoholic steatohepatitis. Acquired hepatic glycogenosis is characterized by intrahepatocyte glycogen accumulation in poorly controlled type 1 diabetes under treatment with high doses of insulin. We report the case of a diabetic teenager with progressive elevation of liver enzymes associated with poor metabolic control. After ruling out other causes of hepatic derangement, we made a clinical diagnosis of secondary hepatic glycogenosis without performing liver biopsy, as all parameters improved after better glycemic control was achieved. Secondary hepatic glycogenosis is probably more frequent than previously reported. This process is reversible and has a benign clinical course that depends on good metabolic control. Diagnosis can be made clinically. Liver biopsy should be reserved for patients with no improvement in liver tests after good metabolic control has been achieved (AU)
Subject(s)
Humans , Male , Adolescent , Glycogen Storage Disease/complications , Diabetes Mellitus, Type 1/etiology , Diabetes Mellitus, Type 1/metabolism , Liver Diseases/complications , Glycogen Storage Disease/diagnosis , Glycogen Storage Disease/therapy , Liver Diseases/diagnosis , Liver Diseases/therapyABSTRACT
There are several manifestations of hepaticinvolvement in diabetes but the most frequent is non-alcoholic steatohepatitis. Acquired hepatic glycogenosis is characterized by intrahepatocyte glycogen accumulation in poorly controlled type 1 diabetes under treatment with high doses of insulin. We report the case of a diabetic teenager with progressive elevation of liver enzymes associated with poor metabolic control. After ruling out other causes of hepatic derangement, we made a clinical diagnosis of secondary hepatic glycogenosis without performing liver biopsy, as all parameters improved after better glycemic control was achieved. Secondary hepatic glycogenosis is probably more frequent than previously reported. This process is reversible and has a benign clinical course that depends on good metabolic control. Diagnosis can be made clinically. Liver biopsy should be reserved for patients with no improvement in liver tests after good metabolic control has been achieved.
