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Erythrocyte insulin binding studies in growth hormone deficiency

Growth hormone (GH) is known to induce insulin resistance, although the mechanism of this action is poorly understood. To investigate whether GH or somatomedin (SM) may alter insulin binding at the cell surface receptor, we have studied in GH deficient (GHD) children the effect of acute and long-term GH therapy on erythrocyte insulin receptor binding (IRB). Fifteen GHD, ages 2-13 years, were evaluated before treatment, after short-term high-dose GH (2 mg bid × 7d), and long-term maintenance GH therapy (2 mg tiw × 2-12 mo). IRB was measured after fasting (16 hrs) and feeding (4 hrs). Fasting IRB was similar in GHD, control children and adults: 8.2±2.4, 7.4±2.4, and 8.2±2.3%, respectively. Corresponding concentrations of serum glucose were 78, 88, 82 mg/dl, those of insulin 12.2±3.4, 17.3±3.4, 11.2±2.8 μU/ml. There was no change of IRB in GHD with feeding vs fasting or short-term high-dose (7.3±2.9) vs long-term maintenance GH therapy (7.0±3.1). GH increased (<2 ng/dl to 22±4.3 ng/dl) and SM (0.36±.20 to 1.3±35 U/ml). A significant inverse correlation was noted between IRB and body weight:height ratios. Those patients with high weight: height ratios had elevated fasting insulin levels (>20 μU/ml), but very low IRB (3.1±1.2). IRB after GH treatment increased only in those patients in whom therapy was associated with a decrease in body weight:height ratios, suggesting IRB may be related more to changes in body fat than circulating GH or SM concentration.