Long-term Effects of Recombinant Human Insulin-like Growth Factor Ⅰ Treatment on Glucose and Lipid Metabolism and the Growth of a Patient with Congenital Generalized Lipodystrophy

摘要

Congenital generalized lipodystrophy (CGL) is a disease characterized by generalized lack of body fat, insulin resistance, hypertriglyceridemia, and fatty liver. We studied the long-term effects of recombinant human insulin-like growth factor Ⅰ (rhIGF-1) treatment on glucose and lipid metabolism and the growth in a patient with CGL. During rhIGF-I treatment, the serum triglyceride level was maintained almost within the normal range, and the plasma glycosylated hemoglobin A1c (HbA1c) levels were maintained under 8.0% (5.8%-7.9%). Thus, rhIGF-Ⅰ treatment was effective in lowering glucose and triglyceride levels over the long-term in a CGL patient. However, it was difficult to suppress the patient's voracious appetite. Although serum total IGF-Ⅰ levels were extremely high (1000-1700 ng/ml), growth was not accelerated after the start of rhIGF-Ⅰ treatment, likely because of normal IGF binding protein 3 (IGFBP-3) levels. During rhIGF-Ⅰ treatment, the patient developed a recurrence of mild hypertrophic cardiomyopathy and a mild elevation of intraocular pressure.