Abstract
Both normal and diabetic children demonstrate impaired insulin-stimulated glucose metabolism during puberty, and adults are similar to prepubertal children in this regard. To determine whether the impairment observed in normal pubertal children occurs in children with PP, we performed oral glucose tolerance tests in 21 children (16 girls, 5 boys; mean age 6.3 y, range 1.1 to 9.6 y) with true PP prior to the inception of the GnRHa nafarelin (NAF) intranasally. Glucose (1.75 g/kg to a maximum of 75 g) was administered po and samples obtained for blood glucose and plasma insulin (IRI) at 0, 30, 60, 120 and 180 min. We studied 16 of the pts during the course of a GnRH infusion test (2 ug/kg/h IV). 11 of the pts (10 girls, 1 boy) were restudied 6 to 12 months following the inception of NAF therapy. All pts were nonobese, on no interfering medications and had fasting euglycemia. Dita were compared to those for a group of 9 normal adult males (mean age 22.6 y.)
Although glucose hcmeostasis was normal in both children and adults, basal IRI (14.0 ± 2.0 uU/ml) in the children with PP was more than double that in adults (6.3 ± 1.0, p <0.005) and 180 min IRI (35.0 ± 5.2) was 3.7 times that of adults (9.6 ± 3.1, p <0.001). All intermediate IRI values were higher in the children than in the adults, although not statistically significant. NAF therapy did not change glucose or IRI response.
These data are consistent with sex steroids mediating the impairment of insulin-stimulated glucose metabolism in precocious puberty. This impairment does not appear to be readily reversible by NAF therapy.
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Burstein, S., Cuttler, L., Moll, G. et al. ELEVATED INSULIN LEVELS IN PRECOCIOUS PUBERTY (PP). Pediatr Res 21 (Suppl 4), 173 (1987). https://doi.org/10.1203/00006450-198704010-00041
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DOI: https://doi.org/10.1203/00006450-198704010-00041