고인슐린혈증을 동반하지 않은 인슐린종 1예

최성일,박용수,이창범,김동선,최웅환,박재일,윤재희,안유헌,김태화,백홍규,장세진,박용욱 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

Insulinoma is a rare neuroendocrine tumor that originates from islet cells of the pancreas. Endogenous hyperinsulinemia causes characteristic symptoms of hypoglycemia. Diagnosis of insulinoma usually requires demonstration of repeated attacks of hypoglycemia (glucose less than or equal to 40 mg/dl), symptomatic relief with the administation of glucose, the documentation of the hyperinsulinemia (serum insulin greater than 6μU/ml) considering hypoglycemia, and the absence of insulin antibidies. Other supplementary laboratory measurements such as plasma c-peptide, proinsulin, and serum immunoreactive insulin to fasting glucose (IRI/G) ratio would be helpful. Sometimes the provocation tests are also applied to detect an autonomic secretion of insulin, when hyperinsulinemia is not evident. Increased serum IRI/G ratio (Fajans index; normal range, below 0,3) has been considered a very sensitive and specific marker to diagnose the insulinoma without peripheral hyperinsulinemia to take the physiologic low serum insulin level at the time of hypoglycemia into account. However, it is not always useful to apply the increased serum IRI/G to diagnose the latent syndrome caused by insulinoma. Despite adequate work-up for the location, insulinoma may be occult and even difficult to diagnose. Some patients with insulinoma might have frequent hypoglycemic episodes with normal plasma insulin levels and insulin/glucose ratio, because of the periodicity of the secretion of insulin. Recently, we experienced a case of insulinoma neither with peripheral hyperinsulinemia nor with increased IRI/glucose ratio at the time of hypoglycemic episodes. Abdominal angiography revealed a hypervascular tumor. It may be suggested that insulinoma should be considered as one of the caused (for the differential diagnosis) in the presence of unexplained hypoglycemic attacks even when there is no evident hyperinsulinemia.

홍삼추출물(KGC05P0)이 고인슐린혈증 제2형 당뇨병 마우스에서 인슐린 민감성, 인슐린 분비량 및 혈당 조절에 미치는 영향

권한올(Hanol Kwon),구기방(Gi-Bang Koo),이윤지(Yun Ji Lee),김종한(Jonghan Kim),이미향(Mi-Hyang Lee),인교(Gyo In) 한국식품영양과학회 2020 한국식품영양과학회지 Vol.49 No.6

본 연구에서는 홍삼 비사포닌 분획 추출물(KGC05P0)이 인슐린 민감성 향상과 아디포넥틴의 연관성 및 그에 따른 혈당변화에 미치는 영향을 확인하기 위하여 고인슐린혈증 및 제2형 당뇨 동물모델에서 간조직의 인슐린 민감도 활성 단백질, 혈중 포도당 수치, 혈중 인슐린 수치, 혈중 아디포넥틴 수치의 변화를 살펴보았다. 그 결과 인슐린 민감성을 향상시키는 단백질 발현 증가와 혈중 아디포넥틴 수치 증가 및 공복혈당, 인슐린 농도를 감소시켜 고인슐린혈증 억제 및 항당뇨 효과를 나타내는 것을 확인하였다. 특히 KGC05P0은 양성대조군인 metformin과 유사한 수준으로 지표들을 개선하여 metformin이 나타낼 수 있는 lactic acidosis와 같은 부작용이 없고 건강한 혈당 유지에 도움을 주는 소재로 사용가능성을 시사하였다. 따라서 KGC05P0는 고인슐린혈증의 제2형 당뇨병 모델에서 간기능의 향상과 함께 인슐린 민감성과 관련된 지표들의 활성화를 통해 혈당 조절에 효능이 있음을 확인하였다. Korean red ginseng extracts (KGC05P0) showed anti-diabetic activity, especially regarding fasting blood glucose and insulin sensitivity in vivo, in this study. To confirm their effectiveness in animals, C57BL/6J ob/ob (hyperinsulinemia/diabetic model) mice were orally administrated with or without KGC05P0 for 12 weeks. The experimental group was divided as follows: NC (C57BL/6J mice), C (C57BL/6J ob/ob mice), Met 200 (metformin, 200 mg/kg b.w.), P0 100(KGC05P0, 100 mg/kg b.w.), P0 200(KGC05P0, 200 mg/kg b.w.), and P0 400(KGC05P0, 400 mg/kg b.w.). We found that KGC05P0 significantly reduced fasting glucose and insulin levels in serum and increased the serum adiponectin level. KGC05P0 improved insulin sensitivity modulators such as IR, IRS-1, PI3K, Akt, AMPK, and GLUT2/4 and inhibited liver function indicators in the liver. This suggests that KGC05P0 has great potential as a health food for improving blood glucose.

Role of Hyperinsulinemia and Glucose Intolerance in the Pathogenesis of Nonalcoholic Fatty Liver in Patients with Normal Body Weight

(Joon Hyoek Lee),(Poong Lyul Rhee),(Jong Kyun Lee),(Kyu Taek Lee),(Jae Jun Kim),(Kwang Cheol Koh),(Seung Woon Paik),(Jong Chul Rhee),(Kyu Wan Choi) 대한내과학회 1998 The Korean Journal of Internal Medicine Vol.13 No.1

N/A Objectives : The pathogenesis of nonalcoholic fatty liver in non - obese persons is poorly understood. We aimed to elucidate whether hyperinsulinemia and glucose intolerance are associated with development of fatty liver in patients with normal body weight Methods : Forty - seven ents with fatty liver were divided into non-obese (n=25) and obese groups (n=22) according to age adjusted body mass index. Inclusion criteria were as follows: (I) elevated transaminase levels during more than 3 months of follow up period, (2) no detectable HBsAg or anti-HCV in the serum, (3) alcohol consumption less than 40 gm/week, (4) no use of potential hepatotoxic drugs within 3 months and (4) sonographic evidence of fatty liver(moderate to severe degree). Baseline insulin levels and oral glucose tolerance test using 75gm of glucose were performed and the results were compared in each group of patients. Results : Mean baseline insulin levels were elevated in both groups above the reference value, 9.3± 3.5 μU/L in non-obese group and 9.9±3.5 μU/L in obese group (p=0.26). Seventeen of non-obese patients (68%) had elevated basal insulin level and 16 of obese patients (73%) had elevated basal insulin level (p=0.39). In oral glucose tolerance test, there was no difference in glucose level between non-obese and obese groups from O minute to 180 minutes (p > 0.05). Eleven patients from the non-obese group (44%) and 8 patients from the obese group (36%) had either impaired glucose tolerance or diabetes (p=0.29). Conclusion : Our data suggest that hyperinsulinemia and glucose intolerance may play a role in the pathogenesis of fatty liver in patients with normal body weight as well as in patients with obesity.

지속적인 경한 고혈당과 고인슐린증이 인슐린 저항성의 발생에 미치는 영향

이석강,김용운,박진현,박소영,김종연 영남대학교 의과대학 1995 Yeungnam University Journal of Medicine Vol.12 No.2

포도당 중합체 투여로 유도한 고혈당 및 고인슐린 혈증이 인슐린 저항성의 발생에 미치는 영향을 규명하기 위하여 hyperinsulinemic euglycemic clamp 기법으로 측정한 당제거율, 당주입율 및 간의 당생성율과 방사성동위원소를 이용한 골격근의 당원질합성능을 측정한 본 연구결과를 요약하면 다음과 같다. Hyperinsulinemic euglycemic clamp 기법으로 평형상태에서 측정한 당제거율은 포도당 중합체군에서 혈중 인슐린의 생리적 및 최대농도 모두에서 정상대조군에 비해서 감소하였으며(p<0.05)STZ 당뇨군에서도 최대인슐린 농도에서 감소하였다.(p<0.05). 당 주입율은 생리적 인슐린 농도에서 포도당 중합체군에서 감소하는 경향을 보였으나 최대인슐린 농도에서는 포도당 중합체군과 STZ 당뇨군에서 다같이 유의한 감소를 보였다.(p<0.05). 간의 당생성율은 포도당 중합체군에서 생리적 및 최대인슐린 농도에서 다같이 감소하는 경향이었으며, 최대농도군에서는 유의하게 감소(p<0.05)하였다. STZ 당뇨군에서는 최대인슐린 농도에서 정상대조군 및 포도당 중합체군보다 증가하였다(p<0.05). 골격근과 간의 당원질 합성능은 포도당 중합체군이 정상대조군과 차이가 없었으나 STZ 당뇨군에서는 감소하였다(p<0.05). 이상의 결과로 볼때 포도당 중합체투여로 유도한 고혈당 및 고인슐린증시 말초조직의 인슐린 저항성이 유발되었으나 soleus근과 간의 당원 합성은 장애가 없어서 STZ 당뇨군과 차이를 나타내었다. The effect of persistant mild hyperglycemic hyperinsulinemia on the development of the insulin resistance in rats was studied in vivo. Also, the characteristics of the insulin resistance compared with the insulin resistance of STZ diabetic rats. Persistant mild hyperglycemic hyperinsulinemic rat model was produced by ingestion of glucose polymer for 8 days. The glucose disappearance and infusion rate was measured by hyperinsulinemic euglycemic clamp technique at steady state of blood glucose and insulin levels. The clamped level of blood glucose was 100 mg/dl, and the clamped levels of insulin were70 μ U/ml(physiologic condition) and 3000 μU/ml (supramaximal condition). Hepatic glucose production rate was calculated using measured data. And the glycogen synthetic capacity of skeletal muscle(soleus) and liver was measured after 2 hours of hyperinsulinemic euglycemic clamp study. The glucose disappearance and glucose infusion rate in glucose polymer group was decreased in the both physiological and supramaximal insulin level compared to the rate of the normal control group. The rate of STZ diabetic group wase lowest at supramaximal insulin level among two another experimental groups. The hepatic glucose production rate of glucose polymer group was decreased compared to normal control but increased in STZ diabetic group. The glycogen synthetic capacity of skeletal muscle and liver of glucose polymer group was not significantly different from normal control group, but it was markdly decreased in STZ diabetic group. These results suggest that persistant mild hyperglycemic hyperinsulinemia may induce insulin resistance, but glycogen synthetic capacity is intact.

한국 중년 성인에서 관상동맥경화증의 위험요인들과 혈청 인슐린 농도와의 관계

허갑범(Kap Bum Huh),이현철(Hyun Chul Lee),임승길(Sung Kil Lim),송영득(Young Duk Song),박은주(Eun Ju Park),윤지영(Jee Young Yoon),이종호(Jong Ho Lee),이영해(Young Hae Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.6

N/A Objectives: Hyperinsulinemia has been reported as a risk factor for coronary artery disease in western society. However, Koreans have shown about half of western people in fasting insulin and insulin secretion levels during oral glucose tolerance test (OGTT). The purpose of this study was to determine the relationship of serum insulin levels to various cardiovascular risk factors in healthy middleaged Koreans. Methods: We studied 143 subjects including 97 women and 46 men. Subjects had not received any medication for diabetes, hypertension or hyperlipidemia and had normal liver and kidney function. Anthropometric parameters and abdominal fat areas by computed tomography at the umbilical level were measured. Blood pressure, nutrient intake, total energy expenditure, serum levels of lipids and the levels of glucose, C-peptide, insulin and free fatty acid during OGTT were determined. Hyperinsulinemia was defined as both fasting and 2-hour serum insulin levels above the 80th percentile of respective serum insulin distributon in study subjects after an oral glucose load. Characteristics of hyperinsulinemic subjects were compared to normoinsulinemic subjects matehed for age, sex, and body mass index. Results: In subjects with normal glucose tolerance, hypertriglyceridemic subjects showed significantly higher serum insulin levels at 30, 60, 120 minutes during OGTT than normotriglyceridemic subjects. Similar results were observed in hypertension and low HDL cholesterolemia. A less significant difference was shown in the insulin pattern during OGTT between subjects with high LDL cholesterol and subjects with normal LDL cholesterol. Hyperinsulinemic subjects had significantly higher levels of systolic blood pressure, serum triglycerides, total cholesterol and glucose than normoinsulinernic subject. HDL cholesterol level was significantly lower in hyperinsulinemic subjects than in normoinsulinrnic subjects. No significant difference in the serum LDL cholesterol was found between two groups. Hyperinsulinernic subjects showed an increase in visceral fat area and percent calorie intake per total energy expenditure, compared with normoinsulinemic subjects. Conclusion: Our results showed that insulin levels in middle-aged Koreans are closely related to serum triglycerides and HDL cholesterol levels. In addition, healthy Koreans with normal glucose tolerance and hyperinsulinemia have an increase in risk factors for coronary artery disease such as hypertension, hypertriglyceridemia and low HDL cholesterol levels as compared with healthy subjects with normal insulin level. Therefore, it is recommended that insulin resistance subjects increase insulin sensitivity and decrease serum insulin level through lifestyle modification to prevent coronary artery disease.

Taurine 이 가토 심장전도계에 미치는 영향

이방헌(Bang Hun Lee),김경수(Kyung Soo Kim),김정현(Jeong Hyun Kim),임헌길(Heon Kil Lim),이정균(Chung Kyun Lee),김기순(Kee Soon Kim),김진혁(Jin Hyuk Kim),김찬(Chan Kim) 대한내과학회 1995 대한내과학회지 Vol.49 No.6

N/A Objectives: Hyperinsulinemia has been reported as a risk factor for coronary artery disease in western society. However, Koreans have shown about half of western people in fasting insulin and insulin secretion levels during oral glucose tolerance test (OGTT). The purpose of this study was to determine the relationship of serum insulin levels to various cardiovascular risk factors in healthy middleaged Koreans. Methods: We studied 143 subjects including 97 women and 46 men. Subjects had not received any medication for diabetes, hypertension or hyperlipidemia and had normal liver and kidney function. Anthropometric parameters and abdominal fat areas by computed tomography at the umbilical level were measured. Blood pressure, nutrient intake, total energy expenditure, serum levels of lipids and the levels of glucose, C-peptide, insulin and free fatty acid during OGTT were determined. Hyperinsulinemia was defined as both fasting and 2-hour serum insulin levels above the 80th percentile of respective serum insulin distributon in study subjects after an oral glucose load. Characteristics of hyperinsulinemic subjects were compared to normoinsulinemic subjects matehed for age, sex, and body mass index. Results: In subjects with normal glucose tolerance, hypertriglyceridemic subjects showed significantly higher serum insulin levels at 30, 60, 120 minutes during OGTT than normotriglyceridemic subjects. Similar results were observed in hypertension and low HDL cholesterolemia. A less significant difference was shown in the insulin pattern during OGTT between subjects with high LDL cholesterol and subjects with normal LDL cholesterol. Hyperinsulinemic subjects had significantly higher levels of systolic blood pressure, serum triglycerides, total cholesterol and glucose than normoinsulinernic subject. HDL cholesterol level was significantly lower in hyperinsulinemic subjects than in normoinsulinrnic subjects. No significant difference in the serum LDL cholesterol was found between two groups. Hyperinsulinernic subjects showed an increase in visceral fat area and percent calorie intake per total energy expenditure, compared with normoinsulinemic subjects. Conclusion: Our results showed that insulin levels in middle-aged Koreans are closely related to serum triglycerides and HDL cholesterol levels. In addition, healthy Koreans with normal glucose tolerance and hyperinsulinemia have an increase in risk factors for coronary artery disease such as hypertension, hypertriglyceridemia and low HDL cholesterol levels as compared with healthy subjects with normal insulin level. Therefore, it is recommended that insulin resistance subjects increase insulin sensitivity and decrease serum insulin level through lifestyle modification to prevent coronary artery disease,

한국 중년 남성에서 인슐린 저항성과 관상동맥질환과의 상관성

김미진,김병국,장원철,박정환,조영일,유광하,박형석,진춘조,정상만 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.13 No.-

Background: Patients with coronary artery disease (CAD) often have multiple risk factors including hypertension, diabetes mellitus, smoking and hypercholesterolemia. However, these do not account for total development of coronary artery disease. It has been known that insulin resistance associated with hyperinsulinemia is closely linked with coronary artery disease. The hyperinsulinemia may accelerate the progression of coronary artery disease and inhibit the regression of atherosclerotic plaque. So we studied whether insulin resistance or hyperinsulinemia may be an independent risk factor of coronary artery disease. Methods: From January 2001 to May 2002, after excluding the patients with hypertension, diabetes mellitus, hypercholesterolemia and medication history that may affect the carbohydrate or lipid metabolism, 8 control subjects without chest pain symptom and normal ECG, 38 patients with typical chest pain and significant coronary artery stenosis and 6 patients with typical chest pain and angiographically insignificant stenosis or normal coronary artery (NCA) wereselected We evaluated the baseline clinical characteristics, oral glucose tolerance test with c-peptide, insulin and lipid profile. And then, we calculated the insulin sensitivity index. Results: 1. There were no significant differences in age, body mass index, systolic and diastolic blood pressure among three groups. 2. In NCA and CAD groups, serum cholesterol levels were higher than that of control group but statistically not significant. 3. In oral glucose tolerance test, the fasting plasma glucose levels were not significantly different among three groups. 4. There were significant differences between control and NCA, NCA and CAD in the area under the c-peptide curve. 5. The area under the insulin curve was significantly larger in NCA than that of control. 6. The insulin sensitivity index was significantly lower in CAD than that of control. Conclusion: There was significant difference in insulin sensitivity index between control and CAD. The increased insulin level and insulin resistance in target tissue may play a role in the genesis of atherosclerosis. However, to determine if insulin resistance could be an independent risk factor in coronary artery disease, prospective study in the larger patient population is warranted.

Acanthosis nigricans as a clinical marker of insulin resistance among overweight adolescents

Antonio Videira­Silva,Carolina Albuquerque,Helena Fonseca 대한소아내분비학회 2019 Annals of Pediatirc Endocrinology & Metabolism Vol.24 No.2

Purpose: Acanthosis nigricans (AN) is a hyperpigmented dermatosis associated with obesity and insulin resistance (IR). There is no consensus whether AN extension scoring offers added value to the clinical estimation of IR. In this study we aimed to assess and score AN using both a short and an extended version of the scale proposed by Burke et al. and analyze the relationships of both versions with hyperinsulinemia and IR. Methods: We analyzed data from 139 overweight adolescents (body mass index ≥85th percentile) aged 12–18 with (n=67) or without (n=72) AN who were followed at a pediatric obesity clinic. Results: Adolescents with AN had higher levels of insulin (d=0.56, P=0.003) and HOMA­IR (d=0.55, P=0.003) compared to those without. Neither the short nor the extended versions of AN scores explained either hyperinsulinemia (β=1.10, P=0.316; β=1.15, P=0.251) or IR (β=1.07, P=0.422; β=1.10, P=0.374). The presence of AN alone predicted hyperinsulinemia and the presence of IR in 7.3% (β=2.68, P=0.008) and 7.1% (β=2.59, P=0.009) of adolescents, respectively. Conclusion: Screening for AN at the neck and axilla is a noninvasive and costeffective way to identify asymptomatic overweight adolescents with or at risk of developing IR.

젊은 연령층의 정상 성인남자에서 체지방분포가 당대사에 미치는 영향

최문기(Moon Gi Choi),박성우(Sung Woo Park),박충기(Choong Ki Park),이병두(Byung Doo Rhee),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min) 대한내과학회 1988 대한내과학회지 Vol.35 No.2

N/A The Subgrouping of human obesity might be of importance for the elucidation of the pathogenesis of type II diabetes mellitus, To evaluate the effects of the degree of fatness and regional distribution of fat on hyperinsulinemia (insulin area; IA) and insulin sensitivity (KJTT), standard oGTT during a 3-hour period and insulin tolerance tests were performed on 16 noniabetic young men. Body mass index (BMI), waist to hip circumference ratio (WHR), and the intraabdominal visceral fat to subcutaneous fat ratio (VSR) were measured using an abdominal CT scan. There were significant positive correlations between IA and BMI (r=0.58, p<0.05) and WHR (r=0.76, p<0.001). There were significant negative correlations between KITT and BMI (r=0. 64, p<0.05) and WHR (r=0.64, p<0.05), However, VSR had no significatn correlation with IA (r=0.07) and KlTT (r=0.39). These results suggest that in non- diabetic young men, the intraabdaminal distribution of fat has no influence on hyperinsulinemia and insulin sensitivity, and that upper body obesity and the degree of overall fatness have major roles in the genesis of hyperinsulinemia and insulin insensitivity.

Hyperinsulinemia, Hyperreninemia 및 Hypokalemia를 동반한 공황장애 1례

박시성,김호찬 대한생물치료정신의학회 1998 생물치료정신의학 Vol.4 No.1

요 약 공황장애의 다양한 원인적 가설이 제시되었음에도 불구하고, 그 병태생리적 기전은 불분명하다. 검사소견 또한 다양하고 일관되지 않아 공황장애에 특이적이라고 할 수 없다. 따라서 검사소견 은 진단을 위해 응용될 수 없으며, 공황장애의 진단은 주로 임상적 소견에 의해서 이루어 진다. 반면 공황장애는 여러가지 의학적 상태와 감별을 필요로 한다. 특히 검사소견상의 이상이 동반 될 경우에는 공황발작과의 관계를 살펴보아야 한다. 본 증례는 검사소견상 혈청 K+의 저하, 혈장 insulin과 renin의 상승을 동반한 공황장애이다. 우선 이들 이상소견을 나타낼 수 있는 의학적 질환을 배제하였다. 공황발작과 별도로 환자가 호소하는 사지마비감은 저칼륨혈증에 의한 증상이라고 판단된다. 저칼륨혈증은 증가된 혈장 insulin과 renin에 의해 초래되었을 가능성이 높다. Insulin과 renin의 상승은 공황장애의 -아 드레날린성 기전 및 세로토닌성 기전과 연관될 것이라고 생각된다. Although various etiological hypotheses of panic disorder have been proposed, the pathophysiological mechanism is still unclear. It also has been suggested that some pathology and laboratory findings were useful to diagnose a panic disorder, however, these findings were not specific to panic disorder. On the other hand, several medical conditions have similar symptoms of panic attacks. So, the differential diagnosis must be done between panic disorder and a certain medical condition especially when some abnormal laboratory findings are found in a patient with panic attacks. The authors report a case of panic disorder with abnormal laboratory findings of hypokalemia, hyper- insulinemia and hyperreninemia. The patient complained not only panic attacks with anticipatory anxiety, but tingling and paralyzed sensation on extremities without panic attack. The possible relationships between these abnormal laboratory findings and pathophysiological processes of -adrenergic, serotonergic mechanism of panic disorder are discussed.