Paradoxic elevation of serum growth hormone levels after splenectomy and/or paraesophagogastric devascularization in patients with portal hypertension

Abstract

Blood glucose, serum immunoreactive insulin (IRI), and serum growth hormone (GH) levels during 50-g oral glucose tolerance tests (OGTT) were determined before and after splenectomy with or without paraesophagogastric devascularization in patients with portal hypertension (13 liver cirrhosis and 8 idiopathic portal hypertension) and in 5 splenectomized patients with diseases other than portal hypertension. Before splenectomy with devascularization, only 1 of 15 patients with portal hypertension exhibited a paradoxic elevation of serum GH levels of more than 10 ng/ml above the fasting levels after glucose loads. After the operation, however, 10 of these 15 patients showed the paradoxic elevation. Frequency of the paradoxic elevation was significantly higher after the operation than before ( p < 0.001). The abnormal response of serum GH levels to glucose loads did not correlate with any of the blood glucose concentrations, serum IRI levels, and values for liver function tests. The paradoxic elevation was also observed in 4 of 6 patients with portal hypertension who underwent splenectomy alone without devascularization. These 4 patients with paradoxic elevation were splenectomized 4 wk and 2 1 2 , 20, and 29 yr previously. However, none of 5 splenectomized patients without portal hypertension showed the paradoxic elevation. The reason why the paradoxic elevation was observed after splenectomy only in patients with portal hypertension but not in patients without portal hypertension may be sought for in the changes of portal venous flow rather than splenectomy itself.