SUCCESSFUL TREATMENT OF CUSHING'S SYNDROME SECONDARY TO AN ARGENTAFFINOMA BY BILATERAL ADRENALECTOMY

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OBSERVATIONS ON CLINICAL PATTERNS OF DIABETES MELLITUS IN INDIA

Several points of difference can be made between features of diabetics of the Western world and the tropical countries. In addition to a lower incidence of juvenile diabetes and diabetic coma in the tropics there is a high incidence of marked underweight among diabetics of the older age group as well as the young.

Observations on ninety-six patients at Cuttack, India, reveal that apart from a few cases of juvenile diabetes and a moderate number of elderly-obese patients there is a high incidence of atypical cases. Some of these are young and very lean but require large doses of insulin for control and are not prone to ketosis (“J”) type. Others are middle-aged and generally responsive to sulfonylurea compounds but are very lean even at onset of disease (elderly-lean type).

Division of the patients into two groups, one seen in the hospital wards and the other in the private clinics (domiciliary), makes it apparent that the unusual types of diabetics are for the most part the poorer hospital (ward) patients. Of these 39.8 per cent are “J” type and 43.7 per cent are elderly-lean types compared with zero and 4.9 per cent, respectively, in the domiciliary group.

The hospital patients have been subject to chronic undernutrition and most of them take large carbohydrate meals at long intervals, often only one a day. It is postulated that imposition of this dual stress of intermittent starvation and overload on carbohydrate metabolism may be related to the atypical patterns of clinical diabetes.

HYPEROSMOLAR AND OTHER TYPES OF NONKETOACIDOTIC COMA IN DIABETES

In patients with hyperosmolality as the sole cause or as an important factor in the production of the coma, therapy with hypotonic or isotonic fluids and with insulin, often in amounts less than those generally used in diabetic ketoacidosis, has proved effective in restoring consciousness in many, but not all, instances of hyperosmolar coma. The mortality, however, has been high, usually because of uremia, stroke, massive infection, pancreatitis, etc.

STUDIES OF INCORPORATION OF RADIOACTIVITY INTO LIPIDS BY HUMAN BLOOD. II. PATTERN OF INCORPORATION OF RADIOACTIVITY INTO FATTY ACIDS BY PLATELETS FROM NORMAL SUBJECTS AND PATIENTS IN DIABETIC ACIDOSIS

Platelets from diabetics in acidosis incorporate significantly less C-14 into fatty acids than do platelets from control subjects. This decrease in incorporation of C-14 into fatty acids is not uniform. Incorporation of C-14 into myristic and palmitic acids, fatty acids presumably made by de novo synthesis, is suppressed to a much greater extent than is incorporation into other fatty acids.

Since some of these abnormalities of incorporation of C-14 by platelets from comatose diabetics could represent isotope dilution effects, we have been particularly interested in the analysis of these data in terms of percentage of total fatty acid C-14 incorporated into the various groups of fatty acids. Platelets from diabetics in acidosis have a pattern of incorporation of C-14 into platelet fatty acids which is much different from that of normal platelets. There is a great decrease in percentage of C-14 in myristic and palmitic acid with a relative increase in percentage of C-14 in fatty acids with retention time corresponding to arachidic acid (20:0) or greater. A significant increase in relative percentage of C-14 in fatty acids containing ten carbons or less is also seen. These findings presumably mean that the cytoplasmic or malonyl CoA pathway, which is involved primarily in synthesis of palmitic and myristic acids, is suppressed greatly in diabetic acidosis, while the mitochondrial or chainlengthening pathway is suppressed to a much smaller degree, or is actually stimulated. It is, therefore, important to consider qualitative as well as quantitative alterations in fatty acid synthesis in diabetes.

CHANGES IN ADIPOSE TISSUE ACCOMPANYING PHEOCHROMOCYTOMA

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INSULIN RESISTANCE AND ACANTHOSIS NIGRICANS

Studies are reported of a twenty-five-year-old woman with insulin resistance. Daily insulin dosage fluctuated, ranging from zero to a maximum of 177,500 units on one day. Associated conditions were acanthosis nigricans, multiple infections, cerebellar infarction, renal vein thrombosis, and chronic nephritis. Plasma obtained during resistance to large insulin dosage yielded high insulin content by immunoassay, high insulin-like activity by rat diaphragm, fat pad and mouse hypoglycemia assays, and no excessive binding capacity by the cellulose-trapping method. Plasma obtained after forty-two days without insulin treatment caused glycogen synthesis in the rat diaphragm. The cause of the resistance was unknown.