Abnormal Glucose Homeostasis and Fasting Intolerance in Patients with Congenital Porto-systemic Shunts

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2023 Sep 4

PMID 37664849

Authors

Mirjam E van Albada

Pratik Shah

Terry G J Derks

Sabine Fuchs

Judith J M Jans

Valerie McLin

Hubert P J van der Doef

Affiliations

Soon will be listed here.

Abstract

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.

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