Severe islet amyloidosis in congenital generalized lipodystrophy
Severe islet amyloidosis in congenital generalized lipodystrophy. A Garg , M Chandalia and F Vuitch Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas 75235-9052, USA. garg@crcvax.swmed.edu Abstract OBJECTIVE: Islet amyloidosis may be one mechanism for pancrea...
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Published in | Diabetes care Vol. 19; no. 1; pp. 28 - 31 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Alexandria, VA
American Diabetes Association
01.01.1996
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Subjects | |
Online Access | Get full text |
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Summary: | Severe islet amyloidosis in congenital generalized lipodystrophy.
A Garg ,
M Chandalia and
F Vuitch
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas 75235-9052, USA. garg@crcvax.swmed.edu
Abstract
OBJECTIVE: Islet amyloidosis may be one mechanism for pancreatic islet beta-cell loss that is associated with the development
of NIDDM. However, the question remains whether chronic overstimulation of insulin and islet amyloid polypeptide (IAPP) secretion
in states of insulin resistance could lead to formation of islet amyloidosis and hence NIDDM in some patients. We studied
pancreatic islet pathology in congenital generalized lipodystrophy, a genetic syndrome of extreme insulin resistance that
may provide some clues. RESEARCH DESIGN AND METHODS: Our patient was a 24-year-old African-American woman with congenital
generalized lipodystrophy. Severe acanthosis nigricans was noted in her since age 6. At ages 12 and 16, normal and impaired
glucose tolerances, respectively, were noted on oral glucose tolerance tests but were accompanied by extreme fasting and post-prandial
hyperinsulnemia. Overt diabetes developed at age 18 and she required approximately 180 U of insulin daily. Immediately after
an accidental death at age 24, an autopsy was performed. Pancreatic histology was studied in detail using routine methods
and immunohistochemical techniques. RESULTS: Some scarring of the pancreas as a result of previous episodes of acute pancreatitis
was observed. Severe amyloidosis was noted in 89% of the islets, sparing those that were rich in pancreatic polypeptide-secreting
cells. Amyloid deposits stained intensely on immunostaining with antibodies against amylin. Marked paucity of beta-cells was
evident. The ratio of beta- to alpha-cells was reduced to 1:1 (normal ratio approximately 4:1). CONCLUSIONS: These observations
suggest that chronic presence of extreme insulin resistance may induce premature and severe islet amyloidosis as well as beta-cell
atrophy. |
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Bibliography: | ObjectType-Case Study-3 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-2 |
ISSN: | 0149-5992 1935-5548 |
DOI: | 10.2337/diacare.19.1.28 |