Hyperglucagonaemia in cirrhosis

Abstract

Plasma glucagon and growth hormone concentrations were measured fasting and after oral glucose in 19 patients with portal vein block with extensive portal-systemic shunting but minimal liver cell damage, 11 cirrhotic patients and 12 matched control subjects. Portal vein block patients and controls had similar fasting glucose and glucagon levels (glucose 3.8 ±0.1 mmol/l vs control 3.4±0.1 mmol/l (mean±SEM); glucagon 57.5 ±9.1 pg/ml vs control 51.3±7.8 pg/ml). Cirrhotic patients were hyperglycaemic (cirrhosis 4.3±0.2 mmol/l vs control 3.4 ±0.1 mmol/l, p < 0.01) with significantly elevated glucagon levels (167.3±61.1 pg/ml vs control 51.3 ±7.8 pg/ml, p < 0.05), which suppressed towards control values after oral glucose. There was no correlation between fasting plasma glucagon levels and the degree of portal-systemic shunting in cirrhotic patients. There was a strong correlation between fasting plasma glucagon concentrations and aspartate transaminase levels (r = 0.68; p < 0.01) in cirrhotic and portal vein block patients. Significant elevations of growth hormone were seen only in cirrhotic patients. It is concluded that hyperglucagonaemia is a feature of hepatocellular damage rather than portalsystemic shunting but the relationship between elevated glucagon and growth hormone concentrations and carbohydrate intolerance in cirrhosis remains unclear.