详细记录  
题名:Adequately adapted insulin secretion and decreased hepatic insulin extraction cause elevated insulin concentrations in insulin resistant non-diabetic adrenal incidentaloma patients.
作者:ANDERWALD CH; TURA A; GESSL A; LUGER A; PACINI G; KREBS M;
来源:PLoS One. 2013 Oct 16;8(10):e77326. doi: 10.1371/journal.pone.0077326. [ IF= 3.73 ] ]
URL :10.1371/journal.pone.0077326
日期:20131104
摘要:BACKGROUND: Insulin-resistance is commonly found in adrenal incidentaloma (AI)
patients. However, little is known about beta-cell secretion in AI, because
comparisons are difficult, since beta-cell-function varies with altered
insulin-sensitivity. OBJECTIVES: To retrospectively analyze beta-cell function in
non-diabetic AI, compared to healthy controls (CON). METHODS: AI (n=217,
34%males, 57+/-1years, body-mass-index:27.7+/-0.3kg/m(2)) and CON [n=25,
32%males, 56+/-1years, 26.7+/-0.8kg/m(2)] with comparable anthropometry
(p>/=0.31) underwent oral-glucose-tolerance-tests (OGTTs) with glucose, insulin,
and C-peptide measurements. 1mg-dexamethasone-suppression-tests were performed in
AI. AI were divided according to post-dexamethasone-suppression-test
cortisol-thresholds of 1.8 and 5microg/dL into 3subgroups: pDexa<1.8microg/dL,
pDexa1.8-5microg/dL and pDexa>5microg/dL. Using mathematical modeling, whole-body
insulin-sensitivity [Clamp-like-Index (CLIX)], insulinogenic Index, Disposition
Index, Adaptation Index, and hepatic insulin extraction were calculated. RESULTS:
CLIX was lower in AI combined (4.9+/-0.2mg.kg(-1).min(-1)), pDexa<1.8microg/dL
(4.9+/-0.3) and pDexa1.8-5microg/dL (4.7+/-0.3, p<0.04 vs.CON:6.7+/-0.4).
Insulinogenic and Disposition Indexes were 35%-97% higher in AI and each subgroup
(p<0.008 vs.CON), whereas C-peptide-derived Adaptation Index, compensating for
insulin-resistance, was comparable between AI, subgroups, and CON. Mathematical
estimation of insulin-derived (insulinogenic and Disposition) Indexes from
associations to insulin-sensitivity in CON revealed that AI-subgroups had
~19%-32% higher insulin-secretion than expectable. These insulin-secretion-index
differences negatively (r=-0.45, p<0.001) correlated with hepatic insulin
extraction, which was 13-16% lower in AI and subgroups (p<0.003 vs.CON).
CONCLUSIONS: AI-patients show insulin-resistance, but adequately adapted insulin
secretion with higher insulin concentrations during an OGTT, because of decreased
hepatic insulin extraction; this finding affects all AI-patients, regardless of
dexamethasone-suppression-test outcome.

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