Insulin resistance in a boy with congenital generalized lipodystrophy

Hirokazu Tsukahara, Kiyoshi Kikuchi, Hideshi Kuzuya, Eiko Ito, Yoko Oda, Atsushi Kosaki, Takako Kakehi, Haruo Nishimura, Kazunuri Yamada, Yasunao Yoshimasa, Hiroo Imura, Haruki Mikawa

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Abstract

We have studied insulin resistance in a 12-year-old Japanese boy who presented with congenital generalized lipodystrophy. Oral glucose tolerance test exhibited a diabetic pattern with normal fasting plasma glucose. Results from euglycemic glucose clamp study showed decreases in both insulin sensitivity and responsiveness. Both the patient's erythrocytes and Epstein-Barr virus transformed lymphocytes showed low-normal insulin binding with a slight reduction in binding affinity in the latter. Insulin binding to the cultured fibroblasts was decreased due to a lowered affinity. In addition, they displayed a rightward shift of the insulin dose-response curve for D-14C-glucose uptake with no decrease in the maximum uptake. Insulin-stimulated autophosphorylation and kinase activity of the wheat germ agglutinin purified receptors from the Epstein-Barr virus-transformed lymphocytes appeared normal. The reason for some discrepancies in insulin binding among the cells remains unknown, and we cannot formulate a conclusion as to whether or not a primary binding defect of insulin receptors exists and contributes to insulin resistance in the patient. The decrease in insulin responsiveness demonstrated in the glucose clamp study may result from a defect at the rate-limiting step in the postbinding process of insulin action, presumably a defect in the glucose transport system in muscle tissues. The defect may be secondary to changes in in vivo circumstances.

Original languageEnglish
Pages (from-to)668-672
Number of pages5
JournalPediatric Research
Volume24
Issue number6
DOIs
Publication statusPublished - Dec 1988
Externally publishedYes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    Tsukahara, H., Kikuchi, K., Kuzuya, H., Ito, E., Oda, Y., Kosaki, A., Kakehi, T., Nishimura, H., Yamada, K., Yoshimasa, Y., Imura, H., & Mikawa, H. (1988). Insulin resistance in a boy with congenital generalized lipodystrophy. Pediatric Research, 24(6), 668-672. https://doi.org/10.1203/00006450-198812000-00003