Rare Diseases Symptoms Automatic Extraction
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Adequately adapted insulin secretion and decreased hepatic insulin extraction cause elevated insulin concentrations in insulin resistant non-diabetic adrenal incidentaloma patients.
[adrenal incidentaloma]
Insulin
-resistance
is
commonly
found
in
adrenal
incidentaloma
(
AI
)
patients
.
However
,
little
is
known
about
beta
-cell
secretion
in
AI
,
because
comparisons
are
difficult
,
since
beta
-cell-function
varies
with
altered
insulin
-sensitivity
.
To
retrospectively
analyze
beta
-cell
function
in
non-diabetic
AI
,
compared
to
healthy
controls
(
CON
)
.
AI
(
n
=
217
,
34
%
males
,
57
±
1
years
,
body-mass-index
:
27
.
7
±
0
.
3
kg
/
m
(
2
)
)
and
CON
[
n
=
25
,
32
%
males
,
56
±
1
years
,
26
.
7
±
0
.
8
kg
/
m
(
2
)
]
with
comparable
anthropometry
(
p
≥
0
.
31
)
underwent
oral
-glucose-tolerance-tests
(
OGTTs
)
with
glucose
,
insulin
,
and
C-
peptide
measurements
.
1
mg
-dexamethasone-suppression-tests
were
performed
in
AI
.
AI
were
divided
according
to
post-dexamethasone-suppression-test
cortisol-thresholds
of
1
.
8
and
5
µg
/
dL
into
3
subgroups
:
pDexa
<
1
.
8
µg
/
dL
,
pDexa
1
.
8
-
5
µg
/
dL
and
pDexa
>
5
µg
/
dL
.
Using
mathematical
modeling
,
whole-body
insulin
-sensitivity
[
Clamp-like-
Index
(
CLIX
)
]
,
insulinogenic
Index
,
Disposition
Index
,
Adaptation
Index
,
and
hepatic
insulin
extraction
were
calculated
.
CLIX
was
lower
in
AI
combined
(
4
.
9
±
0
.
2
mg
·
kg
(
-
1
)
·
min
(
-
1
)
)
,
pDexa
<
1
.
8
µg
/
dL
(
4
.
9
±
0
.
3
)
and
pDexa
1
.
8
-
5
µg
/
dL
(
4
.
7
±
0
.
3
,
p
<
0
.
04
vs
.
CON
:
6
.
7
±
0
.
4
)
.
Insulinogenic
and
Disposition
Indexes
were
35
%
-
97
%
higher
in
AI
and
each
subgroup
(
p
<
0
.
008
vs
.
CON
)
,
whereas
C-
peptide-derived
Adaptation
Index
,
compensating
for
insulin
-resistance
,
was
comparable
between
AI
,
subgroups
,
and
CON
.
Mathematical
estimation
of
insulin
-derived
(
insulinogenic
and
Disposition
)
Indexes
from
associations
to
insulin
-sensitivity
in
CON
revealed
that
AI-subgroups
had
~
19
%
-
32
%
higher
insulin
-secretion
than
expectable
.
These
insulin
-secretion-index
differences
negatively
(
r
=
-
0
.
45
,
p
<
0
.
001
)
correlated
with
hepatic
insulin
extraction
,
which
was
13
-
16
%
lower
in
AI
and
subgroups
(
p
<
0
.
003
vs
.
CON
)
.
AI-patients
show
insulin
-resistance
,
but
adequately
adapted
insulin
secretion
with
higher
insulin
concentrations
during
an
OGTT
,
because
of
decreased
hepatic
insulin
extraction
;
this
finding
affects
all
AI-patients
,
regardless
of
dexamethasone-suppression-test
outcome
.
Diseases
Validation
Diseases presenting
"insulin secretion"
symptom
adrenal incidentaloma
aromatase deficiency
cushing syndrome
familial hypocalciuric hypercalcemia
pyruvate dehydrogenase deficiency
severe combined immunodeficiency
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