Hyperinsulinemia in children and adolescents after bone marrow transplantation.
We report 34 patients (aged 5-18 years) with acute (n = 26) or chronic (n = 1) leukemia, non-Hodgkin's lymphoma (n = 3) or severe aplastic anemia (n = 4) evaluated for pancreatic beta-cell function 9 months to 10.2 years after autologous (n = 19) or allogeneic (n = 15) BMT. Before BMT, all patients received cytotoxic drugs, combined with total body irradiation (TBI) in 24 cases or thoracoabdominal irradiation (TAI) in 4 children. Patients were investigated for fasting blood glucose (FBG), HbA1C, anti-insulin (IAA) and islet cell antibodies (ICA), first-phase insulin response (FPIR) and insulinemia/glycemia (I/G) ratio on i.v. glucose tolerance test (GTT) and C-peptide response after glucagon 1 mg i.v. Results were compared with those obtained in 21 age- and sex-matched controls. None of the patients or controls had IAA and/or ICA. FBG and HbA1C were normal in all children. In the patients, glycemia on i.v. GTT was similar to controls whereas insulin levels I/G ratio and FPIR were significantly higher in patients than in controls, as well as C-peptide levels. We divided the patients on the basis of the radiotherapy into group I with TBI (n = 18), group II with TAI (n = 4) and group III who were not irradiated (n = 4). The I/G ratio, FPIR on i.v. GTT and C-peptide response were significantly higher in group I compared with the other two groups and controls. The increased insulin and C-peptide levels in our patients with normal glycemia might be interpreted as a state of insulin resistance, more evident in patients who received TBL.
Lorini
R
R
Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Italy.
Cortona
L
L
Scaramuzza
A
A
De Stefano
P
P
Locatelli
F
F
Bonetti
F
F
Severi
F
F
D000293:Adolescent; D000741:Anemia, Aplastic / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002096:C-Peptide / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005934:Glucagon; D006442:Glycated Hemoglobin / Q000032:analysis; D013006:Growth Hormone / Q000172:deficiency; D006801:Humans; D007006:Hypogonadism / Q000209:etiology; D007037:Hypothyroidism / Q000209:etiology; D007328:Insulin / Q000097:blood* / Q000276:immunology / Q000378:metabolism; D007333:Insulin Resistance; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000187:drug effects / Q000276:immunology / Q000378:metabolism* / Q000528:radiation effects; D007938:Leukemia / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology* / Q000503:physiopathology; D011867:Radioisotope Teletherapy / Q000009:adverse effects; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D001323:Autoantibodies; D001786:Blood Glucose; D002096:C-Peptide; D005934:Glucagon; D006442:Glycated Hemoglobin; D013006:Growth Hormone; D007328:Insulin