Información del artículo
Los pacientes diabéticos tienen concentraciones de hormona del crecimiento (GH) basales y estimuladas más elevadas que los sujetos normales. Las alteraciones en la secreción de GH no son iguales en los diabéticos tipo 1 y tipo 2. Los diabéticos tipo 1 tienen concentraciones basales de GH más elevadas que los sujetos normales, así como en un aumento de la respuesta secretora ante distintos estímulos. En la diabetes tipo 2 la respuesta de GH ante GHRH en algunos casos se ha encontrado disminuida, tanto en obesos como en delgados, mientras que en otros casos se encuentra una respuesta similar a la de los sujetos normales.
Esta alteración en los valores de GH es más llamativa en los períodos de mal control metabólico. Esta alteración en la secreción de GH se cree que puede estar implicada en el desarrollo de complicaciones agudas y crónicas asociadas a la diabetes.
Palabras clave:
Secreción de hormona del crecimiento
Diabetes mellitus
Control metabólico
Complicaciones crónicas
Diabetic patients have basal and stimulated concentrations of growth hormone (GH) higher than normal controls. These alterations in GH secretion are not the same in type 1 and type 2 diabetic patients. Type 1 diabetic patients have higher basal GH concentrations than normal subjects and augmented GH response to different provocative stimuli. In type 2 diabetic subjects the GH response to GHRH in some cases was reported to be reduced in both lean and obese type 2 diabetics compared with controls while others report a response similar to controls. These elevations in GH levels are more important in the periods of poor metabolic control. Abnormal GH secretion has been suggested as a causative factor in the development of some of the acute and chronic complications of diabetes.
Key words:
Growth hormone secretion
Diabetes mellitus
Metabolic control
Chronic complications
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Bibliografía
[1.]
A. Giustina, E. Bresciani, C. Tassi, A. Girelli, U. Valentini.
Effect of pyridostigmine on the growth hormone-releasing hormone in lean and obese type II diabetic patients.
Metabolism, 43 (1994), pp. 893-898
[2.]
M. Press, W.V. Tamborlane, M.O. Thorner, W. Vale, J. Rivier, J.M. Gertner, et al.
Pituitary response to growth hormone-releasing factor in diabetes. Failure of glucose-mediated suppression.
Diabetes, 33 (1984), pp. 804-806
[3.]
J.J. Kopchick, J.M. Andry.
Growth hormone (GH), GH receptor and signal transduction.
Mol Genet Metab, 71 (2000), pp. 293-314
[4.]
A. Giustina, J.D. Veldhuis.
Pathophysiology of the neuroregulation of growth hormone secretion in experimental animals and the human.
Endrocr Rev, 19 (1998), pp. 717-797
[5.]
A.D. Howard, S.D. Feighner, D.F. Cully, J.P. Arena, P.A. Liberator, C.I. Rosemblum, et al.
A receptor in the pituitary and hypothalamus that functions in growth hormone release.
Science, 273 (1996), pp. 974-977
[6.]
M. Kojima, H. Hosoda, Y. Date, M. Nakazato, H. Matsuo, K. Kangawa.
Ghrelin is a growth-hormone-releasing acylated peptide from stomach.
Nature, 402 (1999), pp. 656-660
[7.]
K. Takaya, H. Ariyasu, N. Kanamoto, H. Iwakura, A. Yoshimoto, M. Harada, et al.
Ghrelin strongly stimulates growth hormone (GH) release in humans.
J Clin Endocrinol Metab, 85 (2000), pp. 4908-4910
[8.]
P.A. Kelly, J. Djiane, M.C. Postel-Vinay, M. Edery.
The prolactin/ growth hormone receptor family.
Endocr Rev, 12 (1991), pp. 235-251
[9.]
G. Baumann.
Growth hormone binding protein 2001.
J Pediatr Endocrinol Metab, 14 (2001), pp. 355-375
[10.]
A. Bereket, C.H. Lang, S.L. Blethen, M.C. Gelato, J. Fan, R.A. Frost, et al.
Effect of insulin on the insulin-like growth factor system in children with new-onset insulin-dependent diabetes mellitus.
J Clin Endocrinol Metab, 80 (1995), pp. 1312-1317
[11.]
B. Strasser-Vogel, W.F. Blum, R. Past, U. Kessler, A. Hoeflich, B. Meiler, et al.
Insulin-like growth factor (IGF)-I and II and IGF-binding proteins -1, -2, and -3 in children and adolescents with diabetes mellitus: correlation with metabolic control and height attainment.
J Clin Endocrinol Metab, 80 (1995), pp. 1207-1213
[12.]
American diabetes association.
Diagnosis and classification of diabetes mellitus.
Diabetes Care, 25 (2002), pp. S5-S24
[13.]
Diabetes control and complications trial (DCCT).
N Engl J Med, 329 (1993), pp. 977-986
[14.]
United Kingdom Prospective Diabetes Study Group (UKPDS).
Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes.
Lancet, 352 (1998), pp. 837-853
[15.]
A.P. Hansen.
Abnormal serum growth hormone response to exercise in juvenile diabetics.
J Clin Invest, 49 (1970), pp. 1467-1478
[16.]
M. Lorenzi, J.H. Karam, M.B. McIlroy, P.H. Forsham.
Increased growth hormone response to dopamine infusion in insulin-dependent diabetic subjects: indication of possible blood-brain barrier abnormality.
J Clin Invest, 65 (1980), pp. 146-153
[17.]
J. Krassowski, J.P. Felber, H. Rogala, W. Jeske, S. Zgliczynski.
Exaggerated growth hormone response to growth hormone-releasing hormone in type 1 diabetes mellitus.
Acta Endocrinol (COPENH), 117 (1988), pp. 225-229
[18.]
C.M. Asplin, A.C. Faria, E.C. Carlsen, V.A. Vaccaro, R.E. Barr, A. Iranmanesh, et al.
Alterations in the pulsatile mode of growth hormone release in men and women with insulin-dependent diabetes mellitus.
J Clin Endocrinol Metab, 69 (1989), pp. 239-245
[19.]
K. Johansen, A.P. Hansen.
Diurnal serum growth hormone levels in poorly and well-controlled juvenile diabetics.
Diabetes, 20 (1971), pp. 239-245
[20.]
F. Cordido, F.F. Casanueva, C. Diéguez.
Cholinergic receptor activation by piridostigmine restored growth hormone responsiveness after growth hormone-releasing hormone administration in obese subjects: evidence for hypothalamic somatostatinergic participation in blunted GH release of obesity.
J Clin Endocrinol Metab, 68 (1989), pp. 290-293
[21.]
R.F. Villas-Boas, J.C. Ramos-Dias, C. Chipoch, A.M. Lengyel.
Growth hormone (GH) response to GH-releasing peptide-6 in patients with insulin-dependent diabetes mellitus.
Metabolism, 46 (1997), pp. 706-710
[22.]
P.F. Catalina, F. Mallo, A. Andrade, R.V. García-Mayor, C. Diéguez.
Growth hormone (GH) response to GH-releasing peptide-6 in type 1 diabetic patients with exaggerated GH-releasing hormone-stimulated GH secretion.
J Clin Endocrinol Metab, 83 (1998), pp. 3663-3667
[23.]
P.F. Catalina, M.A. Andrade, R.V. García-Mayor, F. Mallo.
Altered GH elimination kinetics in type 1 diabetes mellitus can explain the elevation in circulating levels: bicompartimental approach.
J Clin Endocrinol Metab, 87 (2002), pp. 1785-1790
[24.]
T.J. Merimee, J.A. Burgess, D. Rabinowitz.
Arginine infusion in maturity onset diabetes mellitus. Defective output of insulin and of growth hormone.
Lancet, 1 (1966), pp. 1300-1301
[25.]
P.M. Holland, M.B. Landers, H.E. Lebovitz, M.L. Wolbarsht.
Levo dopa stimulated growth hormone secretion and diabetic retinopathy.
Am J Ophtalmol, 82 (1976), pp. 612-618
[26.]
N.T. Richards, S.M. Wood, N.D. Christofides, S.C. Bhuttacharji, S.R. Bloom.
Impaired growth hormone response to human pancreatic growth hormone releasing factor [GRF(1-44)] in type 2 (non-insulin-dependent) diabetes.
Diabetologia, 27 (1984), pp. 529-534
[27.]
P.G. Kopelman, A.C. Mason, K. Noonan, J.P. Monson.
Growth hormone response to growth hormone releasing factor in diabetic men.
Clin Endocrinol (Oxf), 28 (1988), pp. 33-38
[28.]
G. Williams, M.A. Ghatei, A.R. Diani, G.C. Gerritsen, S.R. Bloom.
Reduced hypothalamic somatostatin and neuropeptide Y concentrations in the spontaneously-diabetic Chinese hamster.
Horm Metab Res, 20 (1988), pp. 668-670
[29.]
M. Solimena, F. Folli, S. Denis-Donini, G.C. Comi, G. Pozza, P. De Camilli, et al.
Autoantibodies to glutamic acid decarboxilase in patient with stiff-man syndrome, epilepsy, and type I diabetes mellitus.
N Engl J Med, 318 (1988), pp. 1012-1020
[30.]
M.I. Wurzburger, G.M. Prelevic, P.H. Sonksen, L.A. Balint-Peric, M. Wheeler.
The effect of recombinant human growth hormone on regulation of growth hormone secretion and blood glucose in insulin-dependent diabetes.
J Clin Endocrinol Metab, 77 (1993), pp. 267-272
[31.]
M.I. Wurzburger, P.H. Sonksen.
Natural course of growth hormone hypersecretion in insulin-dependent diabetes mellitus.
Med Hypotheses, 46 (1996), pp. 145-149
[32.]
A. Bereket, C.H. Lang, T.A. Wilson.
Alterations in the growth hormone –insuline-like growth factor axis in insulin dependent diabetes mellitus.
Horm Metab Res, 31 (1999), pp. 172-181
[33.]
JAMJL Janssen, M.L. Jacobs, F.H.M. Derkx, R.F.A. Weber, A.J. Lely, S.W.J. Lamberts.
Free and total insulin-like growth factor I (IGF-I), IGF-binding protein-1 (IGFBP-1) and IGFBP-3 and their relationships to the presence of diabetic retinopathy and glomerular hyperfiltration in insulin-dependent diabetes mellitus.
J Clin Endocrinol Metab, 82 (1997), pp. 2809-2815
[34.]
M. Press, W.V. Tamborlane, R.S. Sherwin.
Importance of raised growth hormone levels in mediating the metabolic derangements of diabetes.
N Engl J Med, 310 (1984), pp. 810-815
[35.]
J.D. Miller, N.M. Wright, S.E. Lester, N.E. Felsing, J. Linzer, E. Chan, et al.
Spontaneus and stimulated growth hormone release in adolescents with type I diabetes mellitus: effect of metabolic control.
J Clin Endocrinol Metab, 75 (1992), pp. 1087-1091
[36.]
K.M. Thrailkill, T. Quattrin, L. Baker, J.E. Kuntze, P.G. Compton, P.M. Martha Jr..
Cotherapy with recombinant human insulin-like growth factor I and insulin improves glycemic control in type 1 diabetes. RhIGF-1 in IDDM study group.
Diabetes Care, 22 (1999), pp. 585-592
[37.]
C.L. Acerini, C.M. Patton, M.O. Savage, A. Kernell, O. Westphal, D. Dunger.
Randomised placebo-controlled trial of human recombinant insulin-like growth factor I plus intensive insulin therapy in adolescents with insulin-dependent diabetes mellitus.
Lancet, 350 (1997), pp. 1199-1204
[38.]
A.A. Alzaid, L.J. Melton, S.F. Dinneen, R.A. Rizza.
The role of growth hormone in the development of diabetic retinopathy.
Diabetes Care, 17 (1994), pp. 531-534
[39.]
J.E. Poulsen.
Recovery from retinopathy in a case of diabetes with Simmonds' disease.
Diabetes, 2 (1953), pp. 7-12
[40.]
R. Luft, H. Olivercrona, B. Sjogren.
Hypophysectomy in man: esperiences in severe diabetes mellitus.
J Clin Endocrinol Metab, 15 (1955), pp. 391-408
[41.]
T.J. Merimee, J. Zapt, E.R. Froesch.
Insulin-like growth factors. Studies in diabetics with and without retinopathy.
N Engl J Med, 309 (1983), pp. 527-530
[42.]
M. Grant, B. Russell, C. Fitzgerald, T.J. Merimee.
Insulin-like growth factors in vitreous.
Diabetes, 35 (1986), pp. 416-420
[43.]
E.A. Koller, L. Green, J.M. Gertner, M. Bost, S.N. Malozowski.
Retinal changes mimicking diabetic retinopathy in two nondiabetic, growth hormone-treated patients.
J Clin Endocrinol Metab, 83 (1998), pp. 2380-2383
[44.]
D. Blank, M. Riedl, A. Reitner, C. Schnack, G. Schernthaner, M. Clodi, et al.
Growth hormone replacement therapy is not associated with retinal changes.
J Clin Endocrinol Metab, 85 (2000), pp. 634-636
[45.]
G.L. King, M. Brownlee.
The cellular and molecular mechanism of diabetic complications.
Endocrinol Metab Clin North Am, 25 (1996), pp. 255-270
[46.]
S. Takeshita, L.P. Zheng, E. Brogi, M. Kearney, L.Q. Pu, S. Bunting, et al.
Therapeutic angiogenesis. A single intraarterial bolus of vascular endothelial growth factor augments revascularization in a rabbit ischemic hind limb model.
J Clin Invest, 93 (1994), pp. 662-670
[47.]
A. Hellstrom, B. Carlsson, A. Niklasson, K. Segnestam, M. Boguszewski, L. Lacerda, et al.
IGF-1 is critical for normal vascularization of the human retina.
J Clin Endocrinol Metab, 87 (2002), pp. 3413-3416
[48.]
R. Simo, A. Lecube, R.M. Segura, J. García Arumi, C. Hernández.
Free insulin growth factor-1 and vascular endothelial growth factor in the vitreous fluid of patients with proliferative diabetic retinophaty.
Am J Ophthalmol, 134 (2002), pp. 376-382
[49.]
C. Gerhardinger, K.D. McClure, G. Romeo, F. Podesta, M. Lorenzi.
IGF-I mRNA and signaling in the diabetic retina.
Diabetes, 50 (2001), pp. 175-183
[50.]
Y. Nagai, H. Ando, E. Nohara, H. Yamashita, T. Takamura, K. Kobayashi.
Plasma levels of vascular endotelial growth factor in patients with acromegaly.
Horm Metab Res, 32 (2000), pp. 326-329
[51.]
P.J. Blankestijn, F.H.M. Derkx, J.C. Birkenhager, S.W.J. Lamberts, P. Mulder, L. Verschoor, et al.
Glomerular hyperfiltration in insulin-dependent diabetes mellitus is correlated with enhanced growth hormone secretion.
J Clin Endocrinol Metab, 77 (1993), pp. 498-502
[52.]
M.B. Grant, R.N. Mames, C. Fitzgerald, K.M. Hazariwala, R. Cooper-DeHoff, S. Caballero, et al.
The efficacy of octreotide in the therapy of severe nonproliferative and early proliferative diabetic retinopathy: a randomized controlled study.
Diabetes Care, 23 (2000), pp. 504-509
[53.]
S.H. Wilson, M.I. Davis, S. Caballero, M.B. Grant.
Modulation of retinal endothelial cell behaviour by insulin-like growth factor I and somatostatin analogues: implications for diabetic retinopathy.
Growth Horm IGF Res, 11 (2001), pp. S53-S59
[54.]
M.B. Grant, S. Caballero, W.J. Millard.
Inhibition of IGF-1 and b-FGF stimulated growth of human retinal endothelial cells by the somatostatin analogue, octeotride: a potential treatment for ocular neovascularization.
Regul Pept, 48 (1993), pp. 267-268
[55.]
M.I. Davis, S.H. Wilson, M.B. Grant.
The therapeutic problem of proliferative diabetic retinopathy: targeting somatostatin receptors.
Horm Metab Res, 33 (2001), pp. 295-299
[56.]
Growth hormone antagonist for proliferative diabetic retinopathy study group.
The effect of a growth hormone receptor antagonist drug on proliferative diabetic retinopathy [editorial].
Ophtalmology, 108 (2001), pp. 2266-2272
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