PubMed · 11576518
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H E Lebovitz. 2001-09-20. Introduction.. https://doi.org/10.1016/s0002-9149(01)01829-x
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OBJECTIVE: To investigate the effects of tibolone on carbohydrate metabolism, and to compare these effects with those of a sequential regimen of conjugated equine estrogens and medrogestone. METHODS: This was an open-label, multicentre, comparative study. Seventy-two postmenopausal women were randomized to receive either tibolone 2.5 mg/day or conjugated equine estrogens 0.6 mg plus sequential medrogestone 5 mg (CEE/M) for six 28-day cycles. Carbohydrate metabolism was evaluated at baseline and after three and six cycles of treatment by an oral glucose tolerance test (OGTT). A blood sample was taken at 30, 60, 90 and 120 mm after glucose 75 mg dosing for determination of plasma glucose, insulin and connecting peptide (C-peptide) levels. RESULTS: The changes from baseline of glucose, insulin and C-peptide area-under-the-curve (AUC) values were not statistically significant after 3 and 6 months of tibolone or CEE/M treatment. There was a small transitory decrease in HbA(1C) after three cycles of treatment with tibolone. CONCLUSION: The effects of tibolone and CEE/M on carbohydrate metabolism were considered to have no clinical significance.
BACKGROUND: Our purpose was to establish the efficacy of different diagnostic tests for the diagnosis and localization of insulinoma as well as the prognostic value of postoperative glycemia measurements. PATIENTS AND METHOD: Retrospective analysis of all insulinoma patients diagnosed at our hospital over the last fifteen years. Every patient underwent a supervised prolonged fasting and localization imaging tests were performed in positive cases. In the immediate preoperative period, during surgical intervention and immediately after it, an intravenous dextrose solution (10% concentration, 2-3 g/Kg/d infusion rate) was used to avoid hypoglycemia. Glycemia was measured every 6-8 h from the immediate postoperative period until hospital discharge. RESULTS: Seventeen insulinoma cases were identified (incidence 2.5 cases/million/year), 59% women and 41% men. The sensitivity (and positive predictive value) of diagnostic tests was: conventional-contrast CT scan 30% (75%), spiral CT scan 71.42% (100%), arteriography 28.57% (100%) and intraoperative ultrasonography 100% (100%). MRI identified insulinoma in two out of five patients and In-pentetreotide scintigraphy only in one out of five. Patients subsequently developing diabetes mellitus or glucose intolerance had higher levels of postoperative glycemia, which also lasted for more days, and longer need for insulin therapy. However, patients with a recurrence of the tumor did not show rebound hyperglycemia at all. CONCLUSION: Postoperative glycemia could be a useful prognostic factor in patients who develop diabetes mellitus or glucose intolerance after resection of insulinoma and to predict insulinoma recurrence.
Stable isotopes are commonly used as tracers for the measurement of glycerol and glucose kinetics in metabolic studies. Traditionally, the analysis of these isotopes has been performed using gas chromatography-mass spectrometry, which requires that the analytes first be derivatized. The derivatization process adds considerable complexity to the method. Liquid chromatography-mass spectrometry (LCMS) can measure many metabolites directly with limited sample preparation. We present a novel analytical method for the measurement of [1,1,2,3,3-(2)H(5)]glycerol (d(5)-glycerol) and [6,6-(2)H(2)]glucose (d(2)-glucose) isotopic tracer enrichments in human serum in a single run by LCMS. After a simple extraction step, the sample is separated isocratically by HPLC, and the isotopes are measured using positive electrospray ionization with selected ion monitoring of the sodium-adduct ions. The method is linear over a wide range of d(2)-glucose and d(5)-glycerol enrichments. The within-day standard deviation of measurement of serum samples was 0.05 mole% excess (MPE) for d(2)-glucose and 0.25 MPE for d(5)-glycerol. The variation of tracer enrichment among days was about double that measured within 1 day.