Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shunts
In physiological glucose homeostasis, the liver plays a crucial role in the extraction of glucose from the portal circulation and storage as glycogen to enable release through glycogenolysis upon fasting. In addition, insulin secreted by the pancreas is partly eliminated from the systemic circulatio...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1190473/full |
| _version_ | 1797741250831450112 |
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| author | Mirjam E. van Albada Pratik Shah Terry G. J. Derks Sabine Fuchs Judith J. M. Jans Valérie McLin Hubert P. J. van der Doef |
| author_facet | Mirjam E. van Albada Pratik Shah Terry G. J. Derks Sabine Fuchs Judith J. M. Jans Valérie McLin Hubert P. J. van der Doef |
| author_sort | Mirjam E. van Albada |
| collection | DOAJ |
| description | In physiological glucose homeostasis, the liver plays a crucial role in the extraction of glucose from the portal circulation and storage as glycogen to enable release through glycogenolysis upon fasting. In addition, insulin secreted by the pancreas is partly eliminated from the systemic circulation by hepatic first-pass. Therefore, patients with a congenital porto-systemic shunt present a unique combination of (a) postabsorptive hyperinsulinemic hypoglycaemia (HH) because of decreased insulin elimination and (b) fasting (ketotic) hypoglycaemia because of decreased glycogenolysis. Patients with porto-systemic shunts therefore provide important insight into the role of the portal circulation and hepatic function in different phases of glucose homeostasis. |
| first_indexed | 2024-03-12T14:24:06Z |
| format | Article |
| id | doaj.art-2890f2219f7e446abc07dfb33d25ebfc |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-12T14:24:06Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-2890f2219f7e446abc07dfb33d25ebfc2023-08-18T11:23:58ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-08-011410.3389/fendo.2023.11904731190473Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shuntsMirjam E. van Albada0Pratik Shah1Terry G. J. Derks2Sabine Fuchs3Judith J. M. Jans4Valérie McLin5Hubert P. J. van der Doef6Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Pediatric Endocrinology, The Royal London Childrens Hospital, Barts Health National Health Service (NHS) Trust and William Harvey Research Institute, Queen Mary University London, London, United KingdomDepartment of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Metabolic Diseases, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, Utrecht, NetherlandsSwiss Pediatric Liver Center, Department of Pediatrics, Obstetrics, and Gynecology, University of Geneva, Geneva, SwitzerlandDepartment of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsIn physiological glucose homeostasis, the liver plays a crucial role in the extraction of glucose from the portal circulation and storage as glycogen to enable release through glycogenolysis upon fasting. In addition, insulin secreted by the pancreas is partly eliminated from the systemic circulation by hepatic first-pass. Therefore, patients with a congenital porto-systemic shunt present a unique combination of (a) postabsorptive hyperinsulinemic hypoglycaemia (HH) because of decreased insulin elimination and (b) fasting (ketotic) hypoglycaemia because of decreased glycogenolysis. Patients with porto-systemic shunts therefore provide important insight into the role of the portal circulation and hepatic function in different phases of glucose homeostasis.https://www.frontiersin.org/articles/10.3389/fendo.2023.1190473/fullhypoglycaemiahyperinsulinismcongenital porto-systemic shuntportal circulationglucose metabolisminsulin |
| spellingShingle | Mirjam E. van Albada Pratik Shah Terry G. J. Derks Sabine Fuchs Judith J. M. Jans Valérie McLin Hubert P. J. van der Doef Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shunts Frontiers in Endocrinology hypoglycaemia hyperinsulinism congenital porto-systemic shunt portal circulation glucose metabolism insulin |
| title | Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shunts |
| title_full | Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shunts |
| title_fullStr | Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shunts |
| title_full_unstemmed | Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shunts |
| title_short | Abnormal glucose homeostasis and fasting intolerance in patients with congenital porto-systemic shunts |
| title_sort | abnormal glucose homeostasis and fasting intolerance in patients with congenital porto systemic shunts |
| topic | hypoglycaemia hyperinsulinism congenital porto-systemic shunt portal circulation glucose metabolism insulin |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1190473/full |
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