title: Plasma adiponectin as a marker of insulin receptor dysfunction: clinical utility in severe insulin resistance.
abstract: OBJECTIVE
  Severe insulin resistance is associated with high morbidity. Identification of severely insulin-resistant patients who have genetic or acquired insulin receptor dysfunction may aid therapeutic decision making; however, onerous diagnostic tests allied to a low frequency of insulin receptor dysfunction often preclude formal diagnosis. Our previous observation of paradoxical hyperadiponectinemia in insulin receptoropathy provides a possible basis for a simpler and cheaper screening test.
  
  
  METHODS
  Receiver operating characteristics analysis was used to determine diagnostic thresholds for insulin receptoropathy in severe insulin resistance for adiponectin and for the insulin-regulated hepatic proteins sex hormone-binding globulin (SHBG) and IGF binding protein-1 (IGFBP-1).
  
  
  RESULTS
  Adiponectin >7 mg/l in severe insulin resistance had a 97% positive predictive value for insulin receptoropathy and <5 mg/l a 97% negative predictive value. IGFBP-1 and SHBG had lesser, though still significant, utility.
  
  
  CONCLUSIONS
  Use of these markers is likely to have significant value in accelerating the diagnosis of insulin receptoropathies.
authors.affiliation: Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. rks16@cam.ac.uk
authors.forename: Robert K
authors.initials: RK
authors.lastname: Semple
authors.forename: Elaine K
authors.initials: EK
authors.lastname: Cochran
authors.forename: Maria A
authors.initials: MA
authors.lastname: Soos
authors.forename: Keith A
authors.initials: KA
authors.lastname: Burling
authors.forename: David B
authors.initials: DB
authors.lastname: Savage
authors.forename: Phillip
authors.initials: P
authors.lastname: Gorden
authors.forename: Stephen
authors.initials: S
authors.lastname: O'Rahilly
mesh_terms: D052242:Adiponectin / Q000097:blood*; D019943:Amino Acid Substitution; D015415:Biomarkers / Q000097:blood; D006801:Humans; D007328:Insulin / Q000172:deficiency / Q000627:therapeutic use; D007333:Insulin Resistance / Q000235:genetics / Q000502:physiology*; D009154:Mutation; D009765:Obesity / Q000235:genetics; D011972:Receptor, Insulin / Q000172:deficiency* / Q000235:genetics
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D007328:Insulin; D011972:Receptor, Insulin