Carbohydrate metabolism in patients with endometrial carcinoma

Treatment of atypical endometrial hyperplasia with an insulin-sensitizing agent

Endometrial cancer and hyperplasia have long been associated with diabetes. Hyperinsulinemia may have a direct mitogenic effect on the endometrium and may inhibit the effect of progestogen therapy. This case report describes the treatment of a patient with atypical endometrial hyperplasia with an insulin-sensitizing agent. A 37-year-old patient presented after failed treatment of endometrial hyperplasia with progestogen therapy. One month after initiating metformin therapy the patient's endometrial biopsy demonstrated proliferative endometrium. This patient's atypical endometrial hyperplasia regressed after the initiation of treatment with an insulin-sensitizing agent. This relatively new class of drugs may provide an adjunct to the therapy of endometrial hyperplasia.

Insulin action and metabolism in patients with head and neck cancer

Cachexia is a phenomenon commonly observed in patients with cancer, but its etiology is poorly understood. Abnormalities of insulin action and metabolism that have been hypothesized to promote cancer cachexia were investigated in this study using a computerized euglycemic clamp and modified frequently sampled intravenous glucose tolerance test (FSIGT) in a group of malnourished patients with localized head and neck cancer, and in healthy, well-nourished, age- and, sex-matched controls. Glucose disposal rates, determined by the euglycemic clamp at three different rates of insulin infusion did not differ significantly between the two groups. However, mean plasma insulin concentrations at each level of insulin infused were significantly lower in the patients with cancer than in the control subjects resulting in unexpectedly higher calculated insulin metabolic clearance rate in the patients with cancer. Peripheral insulin sensitivity calculated from the slope of glucose disposal versus plasma insulin concentration did not differ between the two groups. Results from the FSIGT demonstrated no difference in insulin sensitivity or insulin-independent glucose disappearance between the two groups. However, whole body glucose appearance was significantly elevated in the patients with cancer. Thus, increased whole body glucose utilization in the absence of insulin resistance or increased insulin-dependent glucose disposal was observed. These data are consistent with the concept of a localized tumor acting as a glucose drain in which case increased glucose appearance and increased insulin clearance would defend against hypoglycemia.

A study of endocrine and metabolic variables in postmenopausal women with endometrial carcinoma

Although an underlying endocrine-metabolic disorder has been implicated as causally related to the development of endometrial carcinoma, data to support such an association are ambiguous and/or contradictory. In this prospective study of 16 consecutive nonobese postmenopausal women with endometrial carcinoma and 16 cancer-free postmenopausal women matched for age and weight, fasting values for growth hormone (GH), insulin, prolactin, follicle-stimulating hormone, luteinizing hormone, estrone (E1), and estradiol (E2) were measured on 3 consecutive days. Intravenous glucose tolerance, pituitary GH release in response to arginine infusion, hyperglycemia, and hypoglycemia, and insulin secretion in response to arginine infusion and to hyperglycemia were analyzed. Our data show that these endocrine-metabolic profiles were not significantly different between the cancer patients and control subjects, suggesting that the postmenopausal women with endometrial cancer who is not obese exhibits no accountable endocrine or metabolic disorders.

Cancer cachexia

Cancer cachexia is characterized clinically by anorexia, early satiety, weight loss. anemia, and marked asthenia. The syndrome is not the result of semistarvation alone but it represents a complex metabolic problem. In the host there are abnormalities in metabolism of energy, carbohydrate, lipid and protein, in water content, in acid-base balance, in electrolyte, mineral and vitamin concentrations, alterations in the activity of host tissue enzymes and changes in endocrine homeostasis and immunologic mechanisms. The cancer initiates and contributes to the genesis of the syndrome but complications of the disease and the treatment may also play a role. Only the control of the cancer can reverse completely the syndrome. It was proposed that cancer peptides throw the host metabolism into a chaotic biochemical state by activating and inactivating host enzymes. This results in increased energy expenditure; the released host metabolites and trapped by the growing cancer.