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t (I)

t (I)

t (I)

t (D)

Key: D, direct effect; I, indirect effect.

aGrowth hormone promotes protein synthesis and hence decreases availability of amino acids for ureogenesis.

Key: D, direct effect; I, indirect effect.

aGrowth hormone promotes protein synthesis and hence decreases availability of amino acids for ureogenesis.

FIGURE 6 Normal glucose tolerance following ingestion of 100 g of glucose in a subject with a growth hormone-secreting pituitary tumor is accompanied by an exaggerated increase in plasma insulin indicative of decreased insulin sensitivity. The shaded area in the right-hand panel represents the plasma insulin response of 43 normal subjects who showed the same changes in glucose concentration after ingestion of 100 g of glucose. (From Daughaday WH, Kipnis DM. The growth promoting and anti-insulin actions of somatotropin. Rec Prog Horm Res 1966;22:49-99.)

FIGURE 6 Normal glucose tolerance following ingestion of 100 g of glucose in a subject with a growth hormone-secreting pituitary tumor is accompanied by an exaggerated increase in plasma insulin indicative of decreased insulin sensitivity. The shaded area in the right-hand panel represents the plasma insulin response of 43 normal subjects who showed the same changes in glucose concentration after ingestion of 100 g of glucose. (From Daughaday WH, Kipnis DM. The growth promoting and anti-insulin actions of somatotropin. Rec Prog Horm Res 1966;22:49-99.)

GH and cortisol on insulin secretion are somewhat paradoxical. Although their effects in adipose tissue, muscle, and liver are opposite to those of insulin, GH and cortisol nevertheless increase the sensitivity of beta cells to signals for insulin secretion and exaggerate responses to hyperglycemia (Fig. 6). When cortisol or growth hormone is present in excess, higher than normal concentrations of insulin are required to maintain blood glucose in the normal range. Higher concentrations of insulin itself may contribute to decreased sensitivity by down-regulating insulin receptors in fat and muscle. Hormonal effects on insulin secretion and sensitivity of tissues to insulin are summarized in Table 4.

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