Synergistic interactions among antiinsulin hormones in the pathogenesis of stress hyperglycemia in humans

Harry Shamoon, R. Hendler, R. S. Sherwin

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

We infused epinephrine, glucagon, and cortisol in combination into healthy overnight-fasted subjects in doses designed to simulate changes in severe stress. When all three hormones were infused simultaneously, glucose levels rose above 200 mg/dl in spite of a 100-200% increase in plasma insulin. In contrast, infusion of each hormone individually produced either a mild (<120 mg/dl) or a transient elevation in the plasma glucose concentration. With the combined hormone infusion, the increment in plasma glucose was 3-fold greater than the sum of the responses to the individual hormones (P < 0.001). The marked hyperglycemia in this setting is a result of ongoing glucose overproduction which is stimulated by epinephrine and glucagon and sustained by cortisol. Furthermore, epinephrine (and possibly cortisol) inhibited glucose disposal despite concomitant hyperinsulinemia. In contrast to their effects on glucose regulation the simultaneous infusion of epinephrine, glucagon, and cortisol failed to cause hyperketonemia. We conclude that the combined infusion of epinephrine, glucagon, and cortisol produces a greater than additive hyperglycemic response in normal humans. These data suggest that the clinical occurrence of fasting hyperglycemia in a setting of hypersecretion of multiple antiinsulin hormones (stress hyperglycemia) may result, at least in part, from synergistic interactions among these hormones.

Original languageEnglish (US)
Pages (from-to)1235-1241
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume52
Issue number6
StatePublished - 1981

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Hyperglycemia
Epinephrine
Hydrocortisone
Hormones
Glucagon
Glucose
Plasmas
Hyperinsulinism
Fasting
Insulin

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Synergistic interactions among antiinsulin hormones in the pathogenesis of stress hyperglycemia in humans. / Shamoon, Harry; Hendler, R.; Sherwin, R. S.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 52, No. 6, 1981, p. 1235-1241.

Research output: Contribution to journalArticle

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