関: compensatory hyperinsulinemia、hyperinsulinemia

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/13 07:09:02」(JST)

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Hyperinsulinism refers to an above normal level of insulin in the blood of a person or animal. Normal insulin secretion and blood levels are closely related to the level of glucose in the blood, so that a given level of insulin can be normal for one blood glucose level but low or high for another. Hyperinsulinism can be associated with several types of medical problems, which can be roughly divided into two broad and largely non-overlapping categories: those tending toward reduced sensitivity to insulin and high blood glucose levels (hyperglycemia), and those tending toward excessive insulin secretion and low glucose levels (hypoglycemia).

Hyperinsulinism due to diminished sensitivity, associated with diabetes risk

Although many factors influence insulin secretion, the most important control is the amount of glucose moving from the blood into the beta cells of the pancreas. In healthy people, even small rises in blood glucose result in increased insulin secretion. As long as the pancreatic beta cells are able to sense the glucose level and produce insulin, the amount of insulin secreted is usually the amount required to maintain a fasting blood glucose between 70 and 100 mg/dL (3.9-5.6 mmol/L) and a non-fasting glucose level below 140 mg/dL (<7.8 mmol/L).

When liver cells and other cells that remove glucose from the blood become less sensitive (more resistant) to the insulin, the pancreas increases secretion and the level of insulin in the blood rises. This increased secretion can compensate for reduced sensitivity for many years, with maintenance of normal glucose levels. However, if insulin resistance worsens or insulin secretion ability declines, the glucose levels will begin to rise. Persistent elevation of glucose levels is termed diabetes mellitus.

Typical fasting insulin levels found in this type of hyperinsulinism are above 20 μU/mL. When resistance is severe, levels can exceed 100 μU/mL.

In addition to being a risk factor for type 2 diabetes, hyperinsulinism due to insulin resistance may increase blood pressure and contribute to hypertension by direct action on vascular endothelial cells (the cells lining blood vessels). Hyperinsulinism has also been implicated as a contributing factor in the excessive production of androgens in polycystic ovary syndrome.

The principal treatments of hyperinsulinism due to insulin resistance are measures that improve insulin sensitivity, such as weight loss, physical exercise, and drugs such as thiazolidinediones or metformin.

Hyperinsulinism due to inappropriate secretion, associated with hypoglycemia

Hyperinsulinism may also refer to forms of hypoglycemia caused by excessive insulin secretion. In normal children and adults, insulin secretion should be minimal when blood glucose levels fall below 70 mg/dL (3.9 mM). There are many forms of hyperinsulinemic hypoglycemia caused by various types of insulin excess. Some of those that occur in infants and young children are termed congenital hyperinsulinism. In adults, severe hyperinsulinemic hypoglycemia is often due to an insulinoma, an insulin-secreting tumor of the pancreas.

Insulin levels above 3 μU/mL are inappropriate when the glucose level is below 50 mg/dL (2.8 mM), and may indicate hyperinsulinism as the cause of the hypoglycemia. The treatment of this form of hyperinsulinism depends on the cause and the severity of the hyperinsulinism, and may include surgical removal of the source of insulin, or a drug such as diazoxide or octreotide that reduces insulin secretion.

That spontaneous hyperinsulinism might be a cause of symptomatic hypoglycemia was first proposed by Seale Harris, MD, 1924, in Journal of the American Medical Association.^[1]

Dr. Seale Harris first diagnosed hyperinsulinism in 1924 ^[2] and also is credited with the recognition of spontaneous hypoglycemia.^[3]

Symptoms

Hyperinsulinism due to reduced insulin sensitivity is usually asymptomatic.^[4] In contrast, hyperinsulinemic hypoglycemia can produce any of the entire range of hypoglycemic symptoms, from shakiness and weakness, to seizures or coma.^[5]

References

^ Harris, Seale (1924). "Hyperinsulinism and disinsulinism" (PDF). Journal of the American Medical Association 83 (10): 729–33. doi:10.1001/jama.1924.02660100003002. ISSN 0098-7484. Retrieved 2010-04-25. Lay summary – Lite for Life is a weight loss company that, for a fee, will help you stick to the recommendations given by Seale Harris. In the above Lay Summary, they therefore see all this from a commercial weight-loss point of view. (2010-04-25). Quote from the original article: «Conclusions:
1. Hyperinsulinism is a condition, perhaps a disease entity, with definite symptoms; i.e. those described as being due to hypoglycemia.
2. It seems probable that one of the causes of hyperinsulinism is the excessive ingestion of glucose-forming foods [...]»
^ "Restore Your Health Safely and Sensibly". Liteforlife.com. Retrieved 2007-02-24.
^ "Seale Harris". Alabama State Archives. Retrieved 2007-02-24.
^ "NIH". NIH.
^ "Hyperinsulinism". NIH.

External links

Hyperinsulinism Germany International
GeneReviews/NCBI/NIH/UW entry on Familial Hyperinsulinism
Netzwerk für Eltern von Kindern mit Hyperinsulinismus
Collaborative Alliance for Congenital Hyperinsulinism
Homepage of the Clinic for Pediatric Surgery, Universitymedicine Greifswald

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1. 幼児の持続性高インスリン血症性低血糖症の病因、臨床的特徴、および診断 pathogenesis clinical features and diagnosis of persistent hyperinsulinemic hypoglycemia of infancy
2. 乳児の持続性高インスリン血症性低血糖症の治療および合併症 treatment and complications of persistent hyperinsulinemic hypoglycemia of infancy
3. 思春期における多嚢胞性卵巣症候群の診断的評価 diagnostic evaluation of polycystic ovary syndrome in adolescents
4. 成人における低血糖：臨床症状、定義、および原因 hypoglycemia in adults clinical manifestations definition and causes
5. 幼児および小児における低血糖症の病因 etiology of hypoglycemia in infants and children

English Journal

Cardiometabolic biomarkers in chronic plaque psoriasis before and after etanercept treatment.

Puig L1, Strohal R, Fuiman J, Pedersen R, Szumski A, Koenig AS, Robertson D, Drexel H.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Dec;25(6):470-81. doi: 10.3109/09546634.2013.848260. Epub 2013 Nov 13.
OBJECTIVE: To assess cardiometabolic biomarkers in patients with psoriasis before and after etanercept treatment.METHODS: Patients with moderate-to-severe plaque psoriasis were randomized to etanercept 50 mg once or twice weekly, double-blinded. Cardiometabolic biomarkers were assessed at baseline
PMID 24219012

Fish oil omega-3 fatty acids partially prevent lipid-induced insulin resistance in human skeletal muscle without limiting acylcarnitine accumulation.

Stephens FB1, Mendis B1, Shannon CE1, Cooper S1, Ortori CA2, Barrett DA2, Mansell P1, Tsintzas K1.
Clinical science (London, England : 1979).Clin Sci (Lond).2014 Sep;127(5):315-22. doi: 10.1042/CS20140031.
Acylcarnitine accumulation in skeletal muscle and plasma has been observed in numerous models of mitochondrial lipid overload and insulin resistance. Fish oil n3PUFA (omega-3 polyunsaturated fatty acids) are thought to protect against lipid-induced insulin resistance. The present study tested the hy
PMID 24611892

Characterization of reproductive, metabolic, and endocrine features of polycystic ovary syndrome in female hyperandrogenic mouse models.

Caldwell AS1, Middleton LJ, Jimenez M, Desai R, McMahon AC, Allan CM, Handelsman DJ, Walters KA.
Endocrinology.Endocrinology.2014 Aug;155(8):3146-59. doi: 10.1210/en.2014-1196. Epub 2014 May 30.
Polycystic ovary syndrome (PCOS) affects 5-10% of women of reproductive age, causing a range of reproductive, metabolic and endocrine defects including anovulation, infertility, hyperandrogenism, obesity, hyperinsulinism, and an increased risk of type 2 diabetes and cardiovascular disease. Hyperandr
PMID 24877633