J.Jpn. Surg. Soc.. 85(5): 468-481, 1984

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Original article

CLINICAL AND EXPERIMENTAL STUDIES ON ELEVATED PLASMA LEVEL OF INSULIN IN CIRRHOTIC PATIENTS WITH PORTAL HYPERTENSION AND PORTOSYSTEMIC COLLATERAL CIRCULATION

Plasma level of immunoreactive insulin (IRI) and C-peptide (CPR), and their responses to intravenous administration of glucagon were studied in 37 patients with cirrhotic portal hypertension during hepatic vein catheterization. IRI and CPR in peripheral vein and hepatic vein were compared with development of portal vein collaterals measured by indocyanine green disappearance tests and portal venograms. In additional 2 cases, the values were compared with those of portal vein blood obtained by percutaneous transhepatic catheterization.
Plasma IRI of peripheral vein in cirrhotic patients, those who had only esophageal varices but did not have remarkable amount of portal vein collateral blood flow, revealed the changes closely resembling the controls. On the contrary, peripheral vein IRI elevated significantly in cirrhotics with large shunt and the values exceeded those of hepatic vein, although responses to the glucagon test were normal.
In experimental study using dogs, peripheral IRI revealed significant increase after the portocaval anastomosis diverting the portal blood containing high IRI into the inferior vena cava, and the values exceeded those of hepatic vein.
It is important to know the development of portal vein collaterals as a major cause of hyperinsulinemia in liver cirrhosis.

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