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We have studied a 2-year-old girl with acanthosis nigricans, glucose intolerance, marked hyperinsulinemia, and somatic features characteristic of the leprechaunism syndrome. Circulating plasma insulin levels were increased up to 50-fold and the patient showed a blunted hypoglycemic response to an injection of exogenous insulin (0.2 units/kg), indicating the presence of severe insulin resistance. Insulin purified from the patient's plasma was normal on the basis of chromatographic, electrophoretic, and immunologic criteria. Furthermore, the purified insulin competed effectively with (125)I-labeled insulin for binding to insulin receptors on cultured IM-9 lymphocytes and rat fat cells and also exhibited normal biological potency when tested on rat fat cells. Anti-insulin receptor and anti-insulin antibodies were not detected in the patient's plasma, and plasma levels of glucagon, growth hormone, and cortisol were normal. Insulin binding to the patient's circulating monuclear leukocytes was only slightly depressed into the low normal range and could not account for the severe insulin resistance. Studies on the patient's fibroblasts revealed normal levels of insulin receptors but a total absence of insulin's ability to accelerate glucose transport. Because rates of glucose transport and metabolism were normal in the basal state in the absence of insulin, we conclude that this patient's insulin resistance is due to an inherited cellular defect in the coupling mechanism between occupied insulin receptors and the plasma membrane glucose transport system.
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
September 1985,
Nihon Naibunpi Gakkai zasshi,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
September 2006,
Zhonghua nei ke za zhi,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
December 1982,
The Journal of clinical endocrinology and metabolism,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
January 1985,
American journal of human genetics,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
November 1980,
The Journal of clinical endocrinology and metabolism,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
June 1986,
The Journal of clinical endocrinology and metabolism,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
October 1986,
Metabolism: clinical and experimental,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
April 1995,
Metabolism: clinical and experimental,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
September 1984,
Acta paediatrica Scandinavica,
M Kobayashi, and
J M Olefsky, and
J Elders, and
M E Mako, and
B D Given, and
H K Schedwie, and
R H Fiser, and
R L Hintz, and
J A Horner, and
A H Rubenstein
May 1995,
The Journal of clinical endocrinology and metabolism,
