Abstract Context Congenital adrenal hyperplasia (CAH) patients have potential normal longevity. However, a greater risk for cardiovascular disease has been reported. Insulin resistance and hyperinsulinemia have been described in CAH patients, whereas the prevalence of overt type 2 diabetes is not higher in CAH than in normal population. Objective To examine the contributions of insulin secretion and of hepatic insulin clearance to compensatory hyperinsulinemia in young insulin-resistant adults with classic CAH due to 21-hydroxylase deficiency (21-OHD). Design Cross-sectional. Setting University outpatient clinics. Methods Fifty-one participants: 21 controls, and 30 CAH (15 virilizing and 15 salt-wasting phenotypes), female/male (33/18), age (mean [SD]): 24.0 (3.6) years, body mass index: 24.6 (4.9)kg/m2 with normal glucose tolerance, were submitted to a hyperglycemic clamp study. Main Outcome Measures Insulin sensitivity, beta cell function, and hepatic insulin clearance using appropriate modeling. Results We found an increased insulin resistance in 21-OHD. The systemic hyperinsulinemia (posthepatic insulin delivery) was elevated in CAH patients. No increases were observed in insulin secretory rate (beta cell function) in the first phase or during the hyperglycemic clamp. The increase in insulin concentrations was totally due to a ~33% reduction in insulin clearance. Conclusion 21-OHD nonobese subjects have reduced insulin sensitivity and beta cell response unable to compensate for the insulin resistance, probably due to overexposure to glucocorticoids. Compensatory hyperinsulinemia is most related with reduced hepatic insulin clearance. The exclusive adaptation of the liver acts as a gating mechanism to regulate the access of insulin to insulin-sensitive tissues to maintain glucose homeostasis.

Hyperinsulinemia

10.1210/clinem/dgab010

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Comparison of Metabolic Effects of Surgical-Induced Massive Weight Loss in Patients with Long-Term Remission Versus Non-remission of Type 2 Diabetes

Obesity Surgery (2012)

Fernanda Filgueira Hirsch José Carlos Pareja Sylka R. Geloneze Élinton Adami Chaim Everton Cazzo

Subclinical infection

10.1007/s11695-012-0589-0

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Gut bacterial markers involved in association of dietary inflammatory index with visceral adiposity

Nutrition (2024)

Renata Germano Borges de Oliveira Nascimento Freitas Ana Carolina Junqueira Vasques Gabriel da Rocha Fernandes Francieli Barreiro Ribeiro Isabela Solar

Association (psychology)

10.1016/j.nut.2024.112371

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Diferentes aferições do diâmetro abdominal sagital e do perímetro da cintura na predição do HOMA-IR Mediciones distintas del diámetro abdominal sagital y del perímetro de la cintura en la predicción del HOMA-IR Different measurements of the sagittal abdominal diameter and waist perimeter in the prediction of HOMA-IR

DOAJ (DOAJ: Directory of Open Access Journals) (2009)

Ana Carolina Junqueira Vasques Lina Enriqueta Frandsen Paez de Lima Rosado Gilberto Paixão Rosado Rita de Cássia Lanes Ribeiro Sylvia do Carmo Castro Franceschini

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Energy Expenditure in 21-Hydroxylase Congenital Adrenal Hyperplasia Patients and Comparison with Predictive Equations

Endocrine Practice (2019)

Daniel Minutti de Oliveira Ana Carolina Junqueira Vasques Ezequiel Moreira Gonçalves Sofia Helena Valente de Lemos‐Marini Gil Guerra‐Júnior

Bioelectrical Impedance Analysis

Resting energy expenditure

Body surface area

Fat free mass

10.4158/ep-2019-0390

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Citations (1)

Practical recommendations for the management of diabetes in patients with COVID-19

The Lancet Diabetes & Endocrinology (2020)

Stefan R. Bornstein Francesco Rubino Kamlesh Khunti Geltrude Mingrone David Hopkins

2019-20 coronavirus outbreak

Betacoronavirus

Coronavirus Infections

Pandemic

Disease management

10.1016/s2213-8587(20)30152-2

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Citations (917)

Cranial radiotherapy predisposes to abdominal adiposity in survivors of childhood acute lymphocytic leukemia

Radiation Oncology (2013)

Adriana Aparecida Siviero‐Miachon Angela Maria Spínola-Castro MariaLúcia deMartino Lee Solange Andreoni Bruno Geloneze

Abstract Background Advances in treatment of acute lymphocytic leukemia increased the likelihood of developing late treatment-associated effects, such as abdominal adiposity, increasing the risk of cardiovascular disease in this population. Cranial radiotherapy is one of the factors that might be involved in this process. The aim of this study was to determine the effect of cranial radiotherapy on adiposity indexes in survivors of acute lymphocytic leukemia. Methods A comparative cross-sectional study of 56 acute lymphocytic leukemia survivors, chronological age between 15 and 24 years, assigned into two groups according to the exposure to cranial radiotherapy (25 irradiated and 31 non-irradiated), assessed according to body fat (dual energy X-ray absorptiometry), computed tomography scan-derived abdominal adipose tissue, lipid profile, and insulin resistance. Results Cranial radiotherapy increased body fat and abdominal adipose tissue and altered lipid panel. Yet, lipids showed no clinical relevance so far. There were significantly more obese patients among those who received cranial radiotherapy (52% irradiated versus 22.6% non-irradiated), based on dual energy X-ray absorptiometry body fat measurements. Nonetheless, no association was observed between cranial radiotherapy and body mass index, waist circumference, waist-to-height ratio or insulin resistance. Conclusions Adolescent and young adult survivors of childhood acute lymphocytic leukemia showed an increase in body fat and an alteration of fat distribution, which were related to cranial radiotherapy. Fat compartment modifications possibly indicate a disease of adipose tissue, and cranial radiotherapy imports in this process.

Acute lymphocytic leukemia

10.1186/1748-717x-8-39

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Citations (18)

Cirurgia bariátrica: de anti-obesidade à anti-diabetes

ComCiência (2013)

Bruno Geloneze

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How Useful are Eq-5d And Zbi In Assessing The Impact of Caring for Alzheimer’s Disease Patients?

Value in Health (2015)