Glucagon: Difference between revisions
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While glucagon can be used clinically to treat various forms of hypoglycemia, it is severely contraindicated in patients with [[pheochromocytoma]], as the drug interaction with elevated levels of [[adrenaline]] produced by the tumor may produce an exponential increase in blood sugar levels, leading to a hyperglycemic state, which may incur a fatal elevation in blood pressure.<ref name="urlpi.lilly.com">{{cite web | url = http://pi.lilly.com/us/rglucagon-pi.pdf | title = Information for the Physician: Glucagon for Injection (rDNA origin) | date = | format = | work = | publisher = Eli Lilly and Company | accessdate = 2011-11-19 }}</ref> Likewise, glucagon is contraindicated in patients with an [[insulinoma]], as its use may lead to rebound [[hypoglycemic|hypoglycemia]].<ref name="urlpi.lilly.com"/> |
While glucagon can be used clinically to treat various forms of hypoglycemia, it is severely contraindicated in patients with [[pheochromocytoma]], as the drug interaction with elevated levels of [[adrenaline]] produced by the tumor may produce an exponential increase in blood sugar levels, leading to a hyperglycemic state, which may incur a fatal elevation in blood pressure.<ref name="urlpi.lilly.com">{{cite web | url = http://pi.lilly.com/us/rglucagon-pi.pdf | title = Information for the Physician: Glucagon for Injection (rDNA origin) | date = | format = | work = | publisher = Eli Lilly and Company | accessdate = 2011-11-19 }}</ref> Likewise, glucagon is contraindicated in patients with an [[insulinoma]], as its use may lead to rebound [[hypoglycemic|hypoglycemia]].<ref name="urlpi.lilly.com"/> |
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=== Emergencies === |
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Glucagon relaxes lower esophageal sphincter and is used in emergencies involving esophageal obstruction <ref>http://www.ncbi.nlm.nih.gov/pubmed/147456416</ref>. |
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==Media== |
==Media== |
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Revision as of 13:17, 20 February 2013
Template:PBB Glucagon, a peptide hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels.[1] The pancreas releases glucagon when blood sugar (glucose) levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream. High blood glucose levels stimulate the release of insulin. Insulin allows glucose to be taken up and used by insulin-dependent tissues. Thus, glucagon and insulin are part of a feedback system that keeps blood glucose levels at a stable level. Glucagon belongs to a family of several other related hormones.
Physiology
Production
The hormone is synthesized and secreted from alpha cells (α-cells) of the islets of Langerhans, which are located in the endocrine portion of the pancreas. In rodents, the alpha cells are located in the outer rim of the islet. Human islet structure is much less segregated, and alpha cells are distributed throughout the islet.
Regulation
Secretion of glucagon is stimulated by:
- Hypoglycemia
- Epinephrine (via β2, α2,[2] and α1[3] adrenergic receptors)
- Arginine
- Alanine (often from muscle-derived pyruvate/glutamate transamination (see alanine transaminase reaction).
- Acetylcholine[4]
- Cholecystokinin
Secretion of glucagon is inhibited by:
- Somatostatin
- Insulin (via GABA)[5]
- Increased free fatty acids and keto acids into the blood
- Increased urea production
Function
Glucagon generally elevates the amount of glucose in the blood by promoting gluconeogenesis and glycogenolysis.
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Glucose is stored in the liver in the form of glycogen, which is a starch-like polymer chain made up of glucose molecules. Liver cells (hepatocytes) have glucagon receptors. When glucagon binds to the glucagon receptors, the liver cells convert the glycogen polymer into individual glucose molecules, and release them into the bloodstream, in a process known as glycogenolysis. As these stores become depleted, glucagon then encourages the liver and kidney to synthesize additional glucose by gluconeogenesis. Glucagon turns off glycolysis in the liver, causing glycolytic intermediates to be shuttled to gluconeogenesis.
Glucagon also regulates the rate of glucose production through lipolysis. Glucagon has a minimal effect on lipolysis in humans.
Glucagon production appears to be dependent on the central nervous system through pathways yet to be defined. In invertebrate animals, eyestalk removal has been reported to affect glucagon production. Excising the eyestalk in young crayfish produces glucagon-induced hyperglycemia.[6]
Mechanism of action
Glucagon binds to the glucagon receptor, a G protein-coupled receptor, located in the plasma membrane. The conformation change in the receptor activates G proteins, a heterotrimeric protein with α, β, and γ subunits. When the G protein interacts with the receptor, it undergoes a conformational change that results in the replacement of the GDP molecule that was bound to the α subunit with a GTP molecule. This substitution results in the releasing of the α subunit from the β and γ subunits. The alpha subunit specifically activates the next enzyme in the cascade, adenylate cyclase.
Adenylate cyclase manufactures cyclic adenosine monophosphate (cyclic AMP or cAMP), which activates protein kinase A (cAMP-dependent protein kinase). This enzyme, in turn, activates phosphorylase kinase, which, in turn, phosphorylates glycogen phosphorylase, converting into the active form called phosphorylase A. Phosphorylase A is the enzyme responsible for the release of glucose-1-phosphate from glycogen polymers.
History
In the 1920s, Kimball and Murlin studied pancreatic extracts, and found an additional substance with hyperglycemic properties. They described glucagon in 1923.[7] The amino acid sequence of glucagon was described in the late 1950s.[8] A more complete understanding of its role in physiology and disease was not established until the 1970s, when a specific radioimmunoassay was developed.
Etymology
Glucagon was named in 1923, probably from the Greek γλυκός sweet, and ἄγειν to lead.[9]
Structure
Glucagon is a 29-amino acid polypeptide. Its primary structure in humans is: NH2-His-Ser-Gln-Gly-Thr-Phe-Thr-Ser-Asp-Tyr-Ser-Lys-Tyr-Leu-Asp-Ser-Arg-Arg-Ala-Gln-Asp-Phe-Val-Gln-Trp-Leu-Met-Asn-Thr-COOH.
The polypeptide has a molecular weight of 3485 daltons. Glucagon is a peptide (nonsteroid) hormone.
Glucagon is generated from the cleavage of proglucagon secreted by pancreatic islet α cells. In intestinal L cells, proglucagon is cleaved to the alternate products glicentin, GLP-1 (an incretin), IP-2, and GLP-2 (promotes intestinal growth).
Pathology
Abnormally-elevated levels of glucagon may be caused by pancreatic tumors, such as glucagonoma, symptoms of which include necrolytic migratory erythema, reduced amino acids, and hyperglycemia. It may occur alone or in the context of multiple endocrine neoplasia type 1.
Uses and contraindications
An injectable form of glucagon is vital first aid in cases of severe hypoglycemia when the victim is unconscious or for other reasons cannot take glucose orally. The dose for an adult is typically 1 milligram, and the glucagon is given by intramuscular, intravenous or subcutaneous injection, and quickly raises blood glucose levels. Glucagon can also be administered intravenously at 0.25 - 0.5 unit. To use the injectable form, it must be reconstituted prior to use, a step that requires a sterile diluent to be injected into a vial containing powdered glucagon, because the hormone is highly unstable when dissolved in solution. When dissolved in a fluid state, glucagon can form amyloid fibrils, or tightly woven chains of proteins made up of the individual glucagon peptides, and once glucagon begins to fibrilize, it becomes useless when injected, as the glucagon cannot be absorbed and used by the body. The reconstitution process makes using glucagon cumbersome, although there are a number of products now in development from a number of companies that aim to make the product easier to use.
Anecdotal evidence suggests a benefit of higher doses of glucagon in the treatment of overdose with beta blockers; the likely mechanism of action is the increase of cAMP in the myocardium, in effect bypassing the β-adrenergic second messenger system.[10]
Glucagon acts very quickly; common side-effects include headache and nausea.
Drug interactions: Glucagon interacts only with oral anticoagulants, increasing the tendency to bleed.
While glucagon can be used clinically to treat various forms of hypoglycemia, it is severely contraindicated in patients with pheochromocytoma, as the drug interaction with elevated levels of adrenaline produced by the tumor may produce an exponential increase in blood sugar levels, leading to a hyperglycemic state, which may incur a fatal elevation in blood pressure.[11] Likewise, glucagon is contraindicated in patients with an insulinoma, as its use may lead to rebound hypoglycemia.[11]
Emergencies
Glucagon relaxes lower esophageal sphincter and is used in emergencies involving esophageal obstruction [12].
Media
See also
- Insulin
- Diabetes mellitus
- Proglucagon
- Glucagon-like peptide-1
- Glucagon-like peptide-2
- Islets of Langerhans
- Pancreas
- Cortisol
References
- ^ Reece J, Campbell N (2002). Biology. San Francisco: Benjamin Cummings. ISBN 0-8053-6624-5.
- ^ Layden, B. T., Durai, V. & Lowe, Jr., W. L. (2010) G-Protein-Coupled Receptors, Pancreatic Islets, and Diabetes. Nature Education 3(9):13
- ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1016/0014-2999(87)90737-0
, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with
|doi=10.1016/0014-2999(87)90737-0instead. - ^ Honey, R. N.; WEIRf, G. C. (1980). "Acetylcholine Stimulates Insulin, Glucagon, and Somatostatin Release in the Perfused Chicken Pancreas". Endocrinology. 107 (4): 1065–1068. doi:10.1210/endo-107-4-1065. ISSN 0013-7227. PMID 6105951.
- ^ Xu E, Kumar M, Zhang Y, Ju W, Obata T, Zhang N, Liu S, Wendt A, Deng S, Ebina Y, Wheeler MB, Braun M, Wang Q (2006). "Intra-islet insulin suppresses glucagon release via GABA-GABAA receptor system". Cell Metab. 3 (1): 47–58. doi:10.1016/j.cmet.2005.11.015. PMID 16399504.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Leinen RL, Giannini AJ (1983). "Effect of eyestalk removal on glucagon induced hyperglycemia in crayfish". Society for Neuroscience Abstracts. 9: 604.
- ^ Kimball C, Murlin J (1923). "Aqueous extracts of pancreas III. Some precipitation reactions of insulin". J. Biol. Chem. 58 (1): 337–348.
- ^ Bromer W, Winn L, Behrens O (1957). "The amino acid sequence of glucagon V. Location of amide groups, acid degradation studies and summary of sequential evidence". J. Am. Chem. Soc. 79 (11): 2807–2810. doi:10.1021/ja01568a038.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ glucagon on dictionary.com
- ^ White CM (1999). "A review of potential cardiovascular uses of intravenous glucagon administration". J Clin Pharmacol. 39 (5): 442–7. PMID 10234590.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ a b "Information for the Physician: Glucagon for Injection (rDNA origin)" (PDF). Eli Lilly and Company. Retrieved 2011-11-19.
- ^ http://www.ncbi.nlm.nih.gov/pubmed/147456416