EFFECTS OF EPINEPHRINE ON GLUCOSE-METABOLISM IN PATIENTS WITH ALCOHOLIC CIRRHOSIS

The cirrhotic liver has been shown to be resistant to the actions of v arious glucoregulatory hormones. The objective of this study was to in vestigate the effects of epinephrine on hepatic glucose metabolism in cirrhotic patients, Thirteen cirrhotic and eight healthy subjects were studied. Hepatic glucose production and turnover of alanine and glyce rol were measured using stable isotope technique before and during 70 and 150 minutes of epinephrine infusion (0.1 mu g/kg/min). beta-Adreno receptor binding sites and affinity in mononuclear leukocyte membranes also were determined Hepatic glucose production and alanine turnover in normals significantly increased during epinephrine infusion, but di d not change in cirrhotics, Glycerol turnover increased after 70 minut es of epinephrine infusion in both groups. Epinephrine induced a signi ficant rise of high-affinity beta-adrenoreceptor binding sites in norm als, yielding a significant correlation between hepatic glucose produc tion and receptor density (r = .94, P < .0001). in cirrhotic patients, similar changes in the number of high-affinity beta-adrenoreceptors w ere observed but no correlation with hepatic glucose production was de tected, The cirrhotic fiver did not respond normally to the stimulator y effect of epinephrine on hepatic glucose production Because this blu nted response was not related to changes of beta-adrenoreceptors, our findings suggest that epinephrine resistance in cirrhosis was caused b y a postreceptor defect.