[Disorder of amino acid metabolism and its correction in chronic disease of the biliary system].
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The composition and blood concentration of free aminoacids and other aminocompounds were investigated using automatic aminoacid analysis by a physiological program in 12 patients with diagnosed corticotropin secreting hypophyseal disease (Itsenko-Cushing disease) before and 1-3 years after proton "hypophysectomy". Imbalance of components of the glucose-alanine cycle, expressed in hypoalaninemia and raised concentration of aminoacids with a bifurcated lateral chain, was detected against a background of marked hypercorticotropinemia and hypercorticolism. Single irradiation of the pituitary gland with a proton beam at absorbed doses of 100-120 Gy in the maximum of a deep field resulted in remission and normalization of aminograms of blood plasma (suggesting pathogenicity of proton-beam therapy) for 6-12 mos. The authors discussed probable mechanisms of the interrelationship of protein-amino-acid and carbohydrate metabolic derangements and their correlation with a type of changes in the hormonal balance.
An intravenous glucose tolerance test (IVGTT) was administered in both lean (n = 9) and obese (n = 14) volunteers to ascertain the importance of the dynamic interactions between insulin and glucose on plasma concentrations of two amino acids known to be primarily used by skeletal muscle, namely leucine and isoleucine, and one amino acid, phenylalanine, which is primarily metabolized by the liver. After a 30-minute basal period, each subject received a bolus injection of glucose (0.3 g/kg IV) followed 20 minutes later by a bolus injection of tolbutamide (300 mg). Blood samples were drawn frequently for 180 minutes after the glucose infusion to determine plasma concentrations of glucose, insulin, leucine, isoleucine, and phenylalanine. Plasma glucose and insulin concentrations during the basal period were increased by 10% and 100%, respectively, in obese compared with lean individuals (P < .05), whereas phenylalanine, isoleucine, and leucine levels were similar between groups. During the IVGTT, plasma glucose level initially increased by twofold and slowly returned to basal level thereafter, whereas insulin level responded to glucose and tolbutamide infusions in a typical biphasic manner. Plasma leucine and isoleucine levels did not change from basal levels during the first 60 minutes of the IVGTT as hyperglycemic hyperinsulinemia prevailed in both groups. However, when plasma glucose had returned to near-basal levels, plasma leucine and isoleucine levels began to decrease, reaching a plateau of approximately 20% and 35% below basal, and plasma insulin level remained elevated in the lean and obese individuals, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Some degrees of protein deficiency, suggestive of abnormal protein metabolism, are a well-known feature of chronic renal failure (CRF). Serum albumin concentration, an index of malnutrition and deranged protein metabolism, is frequently decreased relatively early in CRF, even in absence of heavy proteinuria: a more subtle but characteristic abnormality is found in the plasma profile of amino acids. In addition, there is an accumulation in the plasma and tissues of many products of protein metabolism; some of these have been considered as uremic toxins, while others are largely undefined. The origin of abnormalities in protein metabolism are multifactorial. The defect are caused at least partly by dietary deficiency, as well as by the inability of the failing kidney to excrete normal end products of nitrogen and protein metabolism and by the effect of altered uremic milieu on overall metabolism.
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