Summary
Patients with cirrhosis of the liver often have insulin resistance and elevated circulating
growth hormone levels. This study was undertaken (a) to evaluate glucose intolerance,
insulin resistance and abnormal growth hormone secretion and (b) to determine if GH
suppression improves insulin resistance. Glucose tolerance tests (GTT), intravenous
insulin tolerance tests (IVITT), arginine stimulation tests (AST) and glucose clamp
studies before and during GH suppression with somatostatin were performed in a group
of patients with alcohol-induced liver cirrhosis. During GTT cirrhotic subjects had
a 2-hour plasma glucose of 200±9.8 ng/dl (N=14) compared to 128±8.0 ng/dl in normal
controls (N=15), P < 0.001. Basal GH was elevated in cirrhotic patients and in response
to arginine stimulation reached a peak of 17.0±5.4 ng/ml (N=7), compared to a peak
of 11.3±1.8 ng/ml in 5 normal controls (P=NS). During IVITT patients with cirrhosis
had a glucose nadir of 60.0±4.0 mg/dl (N=9), compared to 29.0±7.0 mg/dl in controls
(N=5), P < 0.001. Peak GH levels during IVITT were not significantly different in
cirrhotics and controls. Glucose utilization rates in 4 patients with cirrhosis of
the liver before somatostatin mediated GH suppression was 3.1±0.5 mg/kg/min and 6.5±1.5
mg/kg/min during somatostatin infusion, P < 0.025.
We conclude that patients with alcohol induced cirrhosis have sustained GH elevations
resulting in insulin resistance which improves after GH suppression.
Key-Words
Growth Hormone
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Cirrhosis
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Diabetes Mellitus
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Glucose Clamp
