Avaliação do comprometimento endócrino do pâncreas em crianças e adolescentes portadores de fibrose cística / Evaluation of the endocrine pancreatic dysfunction in children and adolescents with cystic fibrosis

AUTOR(ES)

Thais Della Manna

DATA DE PUBLICAÇÃO

2006

RESUMO

INTRODUCTION: Cystic fibrosis-related diabetes is a common complication leading to clinical deterioration of these patients. Aiming at an earlier diagnosis, we investigated the kinetics of the glucose-metabolism abnormalities by evaluating glucose, insulin, pro-insulin, C-peptide and glucagon responses after oral glucose (OGTT) and a mixed meal tolerance (MMTT) tests. METHODS: In a cross-sectional and controlled study, conducted from july/2004 till august/2005, 52 children and adolescents with cystic fibrosis, from 5 to 19 years old, underwent both tests in an interval of less than 10 weeks. RESULTS: Plasma glucose values were significantly lower during MMTT after 60 minutes and insulin, C-peptide and glucagon were secreted earlier, being significantly higher at 30 minutes. During OGTT, patients showed a delayed but higher peak insulin, C-peptide and pro-insulin secretion at time 120 minutes. Patients with Cystic Fibrosis-Related Diabetes (CFRD) without fasting hyperglycemia presented insulin, C-peptide and proinsulin values significantly higher than those patients with normal glucose tolerance or pre-diabetes, at time 120 minutes, indicating increased peripheral insulin resistance. An overlap of insulin, C-peptide and pro-insulin levels was observed in normal and pre-diabetic patients as well as in people with CFRD with fasting hyperglycemia, at 120 minutes, suggesting beta cell dysfunction in the latter groups. Conclusion: Mixed meal ingestion caused an earlier hormone secretion stimulated probably by nutrients different from glucose. Insulin resistance besides beta cell dysfunction are involved in the pathogenesis of cystic fibrosis related glucose disturbances.

ASSUNTO(S)

fibrose cística/complicações prognosis co-morbidity children cystic fibrosis/diagnosis fibrose cística/diagnóstico comorbilidade insulin resistance prognóstico cystic fibrosis/complications adolescents diabetes mellitus adolescente pancreatopathy criança diabetes mellitus resistência à insulina pancreatopatias/etiologia

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