Manuel Tzagournis

Interrelationships of Hyperinsulinism and Hypertriglyceridemia in Young Patients with Coronary Heart Disease

Fasting serum lipid levels, glucose tolerance, and immunoreactive insulin concentrations of 50 young patients with coronary heart disease (CHD) and 30 control subjects were evaluated to study the interrelationships of these metabolic factors. Abnormalities in one or more of these factors could be shown in 90% of the patients and 20% of the control subjects. Thirty-four of the 50 patients had elevated cholesterol or triglyceride levels, or both, 30 had abnormally elevated or delayed insulin responses after glucose, and 17 had abnormal glucose tolerance. A significant correlation existed between serum triglyceride and insulin concentrations. When insulin levels were reduced by phenformin, triglyceride concentrations fell toward normal.These findings indicate that carbohydrate, insulin, and lipid abnormalities are rather prevalent in patients with CHD. Excessive insulin secretion secondary to mild glucose intolerance probably induces hepatic synthesis of triglycerides and hypertriglyceridemia. Dietary alterations or pharmacological agents may help to control some of the metabolic abnormalities associated with premature CHD.

Excessive Serum Insulin Response to Oral Glucose in Obesity and Mild Diabetes Study of 501 Patients

Glucose tolerance tests and immunoreactive insulin responses were analyzed in 203 subjects with abnormal glucose tolerance and in 298 nondiabetics. All subjects were grouped as obese (greater than 115 per cent of ideal body, weight) or lean. Those with an abnormal glucose tolerance test were further subdivided: (1) Normal fasting glucose and one or more abnormal subsequent values, and (2) elevated fasting glucose and an abnormal tolerance test. The total mean glucose and insulin concentrations, expressed as the areas under the three-hour glucose tolerance curves, were compared in the six subgroups. Hyperinsulinism was found in obese nondiabetics as compared to lean nondiabetics. Mildly impaired glucose tolerance in both obese and non-obese patients was associated with increased insulin levels compared to nondiabetics. Despite increased immunoreactive insulin levels in subjects with impaired glucose tolerance, the concentrations were less than expected for corresponding glucose levels during the early portion of the tolerance test. Decompensated diabetes, manifested by fasting hyperglycemia, was associated with absolute as well as relative deficiency of endogenous insulin. While definite trends in glucose-induced insulin responses could be determined in specific groups, there was marked individual variation.

Anorexia nervosa—clinical features and long term follow-up

Abstract The clinical features of 60 patients hospitalized with the diagnosis of anorexia nervosa were reviewed. Weight loss, amenorrhea, psychological disturbances, and mild hypotension were frequent clinical manifestations. Laboratory data revealed that a low protein bound iodine and basal metabolism rate were frequently found, however, the patients were euthyroid. Serum proteins and other chemical studies were within the normal limits in the majority of patients. The most consistent endocrinologic abnormality was that of absent or low urinary gonadotropins. The disorder can be a mild one with complete recovery or can persist for many years occasionally terminating in death. Mis-diagnosis of the syndrome is not uncommon and must be differentiated from other diseases which result in malnutrition and emaciation. Follow-up information was reviewed in 53 out of the 60 patients. Sixty-eight per cent of these patients were categorized as either in “satisfactory” or “partially satisfactory” condition. Nine patients have died and the other 11 patients are incapacitated by their illness. The prognosis can often be determined by a careful assessment of the clinical features. Short duration of symptoms, a relatively small weight loss, high educational achievement, age of onset below 30 yr, and mild associated symptoms were correlated with improved prognosis. The type of treatment during hospitalization did not seem to alter the course of the disease.

Serum Insulin, Carbohydrate, and Lipid Abnormalities in Patients with Premature Coronary Heart Disease

Excerpt Abnormal glucose metabolism and elevated serum lipids have been intimately related to atherosclerosis. Coronary atherosclerosis is more prevalent in diabetics than in nondiabetics (1). Conv...

Chronic adult hypervitaminosis A with hypercalcemia

Abstract Severe hypercalcemia due to chronic hypervitaminosis A is described in a young adult. The hypercalcemia responded to parenteral fluids and with-drawal of the medication. During recovery, a negative calcium balance of 320 mg/day and increased urinary excretion of hydroxyproline were found. These data suggest that calcium was excessively mobilized from the skeleton due to an action of vitamin A on bone. With increased use of this vitamin, especially by young people for skin disorders, recognition of hypervitaminosis A is essential to avoid certain major medical problems.

Use of Medium Chain Triglycerides in Malabsorption

Excerpt Recent clinical observations have indicated that triglycerides containing medium chain fatty acids may be useful in decreasing the steatorrhea associated with a variety of malabsorptive dis...

The diabetogenic action of human growth hormone: Glucose - fatty acid interrelationships

Abstract Intravenous glucose tolerance was determined in seven normal subjects. Growth hormone administered 4 1 2 hours prior to the tests resulted in an elevation of plasma free fatty acids and an impairment in glucose tolerance. When 5 - methylpyrazole - 3 - carboxylic acid, an inhibitor of lipolysis, was administered 4 1 2 hours prior to the tests, there was a significant decrease in plasma free fatty acid levels and a slight improvement in glucose tolerance which was not statistically significant. When both compounds were administered 4 1 2 hours prior to the tests, the circulating free fatty acid levels were low and glucose tolerance was significantly improved when compared to the results seen after growth hormone alone but significantly impaired when compared to the results seen after administration of the pyrazole derivative alone. It is concluded that the impairment of glucose tolerance produced by growth hormone is partially but not entirely mediated by the elevated plasma free fatty acid levels produced by the hormone. The mechanism responsible for the residual impairment is unknown.

Stimulation of insulin secretion in man by medium chain triglycerides.

Abstract The effects of an orally administered medium chain triglyceride (MCT) preparation on blood glucose, plasma non-esterified fatty acids (NEFA), and serum insulin levels have been determined in 10 normal volunteers and 9 patients with cirrhosis and evidence of portalsystemic communications. Blood glucose and plasma NEFA levels did not change appreciably in either group. Serum insulin levels increased significantly in the cirrhotic patients. It is suggested that MCT caused a modest stimulation of insulin secretion which was more easily detected in the cirrhotic patients because of (1) a reduced liver cell mass capable of binding insulin during its initial circulation through the liver, and (2) shunting around the liver through portalsystemic communications.

Congestive heart failure complicating the hungry bone syndrome

A patient with the hungry bone syndrome following parathyroidectomy for hyperparathyroidism developed congestive heart failure, probably due to the myocardial depressant effects of hypocalcemia and hypomagnesmia. Calcium and magnesium alone were instrumental in relieving his symptoms, decreasing his heart size, and clearing the pulmonary congestion. A mechanism for the pathogenesis of hypocalcemia and hypomagnesemia induced heart failure is proposed.

Mortality from Coronary Heart Disease During Phenformin Therapy

Abstract A prospective study of 137 patients with premature coronary disease was begun in 1965 to evaluate the influence of phenformin on mortality from cardiovascular disease. The subjects were tr...