Case report
Impaired insulin degradation in a patient with insulin resistance and acanthosis nigricans

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Abstract

The kinetics of plasma insulin were studied in a 14 year old girl with the syndrome of insulin resistance and acanthosis nigricans. The clearance of plasma insulin was found to be strikingly reduced (135 ml/min·m2 versus 456 ± 22 in 17 normal control subjects), whereas the basal systemic insulin delivery rate was increased about 10-fold (25.5 mU/mim·m2 versus 2.6 ± 0.3 in normal subjects). Thus, reduced insulin clearance and excessive posthepatic delivery of the hormone both contributed to the severe fasting hyperinsulinemia (218 μU/ml) associated with the other clinical features of the syndrome (glucose intolerance, primary amenorrhea, polycystic ovaries, hirsutism). Following ovarian wedge resection, insulin clearance rose to 264 ml/min·m2, and insulin delivery fell to 9.8 mU/ min·m2. The resulting abatement of the patient's hyperinsulinism (fasting plasma insulin = 37 μU/ml) was accompanied by the appearance of menses, normalization of glucose tolerance, and amelioration of the acanthosis. The improvement in menstrual function and acanthosis, however, was not sustained. This case provides evidence for interdependence of insulin action and insulin degradation in humans.

References (38)

  • ER Arquilla et al.

    Immunological and biological properties of iodo-insulin labeled with one or less atoms of iodine per molecule

    J Clin Invest

    (1968)
  • AJ Zeleznik et al.

    Demonstration of the insulin receptor in vivo in rabbits and its possible role as a reservoir for the plasma hormone

    J Clin Invest

    (1978)
  • CR Kahn et al.

    The syndromes of insulin resistance and acanthosis nigricans: insulin-receptor disorders in man

    N Engl J Med

    (1976)
  • L Citti et al.

    Radioimmunoassay of labeled and unlabeled insulin mixtures

    J Nucl Biol Med

    (1976)
  • L Heding

    Determination of free and antibody-bound insulin in insulin treated diabetic patients

    Horm Metab Res

    (1969)
  • JS Flier et al.

    Antibodies that impair insulin receptor binding in an unusual diabetic syndrome with severe insulin resistance

    Science

    (1975)
  • RS Bar et al.

    Fluctuations in the affinity and concentration of insulin receptors in circulating monocytes of obese patients

    J Clin Invest

    (1976)
  • JC Sodoyez et al.

    127I-or carrier-free 125I-monoiodoinsulin. Preparation, physical, immunological and biological properties and susceptibility to “insulinase” degradation

    J Biol Chem

    (1975)
  • L Citti et al.

    Monoiodoinsulin specially substituted on A19 tyrosine: preparation, characterization, and determination of the specific radioactivity

    J Nucl Med Allied Sci

    (1977)
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    From the C.N.R Clinical Physiology Institute and Second Medical Clinic, University of Pisa, and the Institute of Clinical Medicine, University of Padua, Italy.

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