Glycogen-laden hepatomegaly in diabetes

Abstract

Summary.A 43-year old man is described who had been treated with insulin for diabetes for 18 years. For the last 3 years he had had nightly hypoglycaemie attacks. He was then found to have an enlarged liver, biopsy of which showed normal architecture but a markedly increased glycogen content. After his insulin was changed so that he no longer developed hypoglycaemia, his liver returned to normal size and normal glycogen content. Previous reports of glycogen-laden hepatomegaly are reviewed, and its mechanism is discussed, with special reference to its reversibility when hypoglycaemia is avoided.Rdsumd. Les auteurs rapportent l'observation d'un hemme ~gd de 43 ans traitd par l'insuline depuis 18 ans. Pendant les 3 derni@res anndes il souffrait d'attaques nocturnes d'hypoglyc6mie. On constata une augmentation du foie dent une biopsie dgmontra une architecture normale, mais des ddpSts considdrablement 61cvds de glyeog6ne. Apr6s abolition des hypoglycdmies par changement d'insuline, le volume et le contenu de glycog6ne du foie rcdevinrent normaux. Des rapports ant6rieurs d'hdpatomdgalie par d6p6t glycogdnique sent passds en revue ; le m6canisme de cette hdpatom6galie et particuli6rement sa reversibilitd, si l'hypoglyc6mie est 6vitde, est discut@. Zusammenfassung. Bericht fiber einen 43-j/~hrigenMann, dcr wegen seines Diabetes 18 Jahre lang mit Insulin behandelt wurde. In den letzten 3 Jahren hatte er n/ichtliche hypoglyk/imische Anf/ille. Die Untersuchung ergab eine vergrSBcrte Leber, deren bioptischc Untersuchung eine normale Struktur, abcr einen dcutlich erhShten Glykogengehalt erkennen liel]. Nachdem das Insulin gewechselt wurde, sodal] I-Iypoglyk/imien nicht mehr auftraten, bildete sich die LebervergrSl~erung zurfick. Sie enthielt jetzt normale Mengen von Glykogen. Uber frfihere Angaben der ,,glycogen-laden hepatomegaly" wird berichtet, ihr Entstehungsmechanismus diskutiert, wobei besonders die Reversibilitat des Zustandes berficksichtigt wird, wenn ttypoglykamien vermieden werden.

Hormonal and Metabolic Responses to Glucagon in Diabetes Mellitus

“…The similar rate of rise of the blood glucose in both diabetics and controls is to be expected if glucagon is stimulating the same hepatic processes. The enhanced peak and duration in diabetics may result from the diminished insulin response to glucagon and the increased levels of liver glycogen often present in treated diabetics (Middleton & Hockaday , 1965).…”

Observations on the structure and function of liver in indian diabetics

“…Divergent opinions have been expressed by Western workers with regard to these findings. Long (1947) believed that insulin, when given in physiologic amounts, inhibited liver glycogen deposition whereas Middleton and Hockaday (1965) observed increased glycogen storage in the liver leading to hepatomegaly if the disease was treated with insulin. Our observations in a few cases indicated that glycogen deposition either remained the same or was decreased to variable extent if the disease was kept adequately controlled for a year.…”