0
Clinical Investigations: NEUROMUSCULAR DISEASE |

Neuroadrenergic Denervation of the Lung in Type I Diabetes Mellitus Complicated by Autonomic Neuropathy*

Raffaele Antonelli Incalzi, MD; Leonello Fuso, MD; Alessandro Giordano, MD; Dario Pitocco, MD; Carmela Maiolo, MD; Maria Lucia Calcagni, MD; Giovanni Ghirlanda, MD
Author and Funding Information

*From the Departments of Internal Medicine (Drs. Antonelli Incalzi, Pitocco, and Ghirlanda), Respiratory Physiology (Drs. Fuso and Maiolo), and Nuclear Medicine (Drs. Giordano and Calcagni), Catholic University, Rome, Italy.

Correspondence to: Leonello Fuso, MD, Fisiopatologia Respiratoria, Università Cattolica S. Cuore, Largo A. Gemelli 8, 00168 Roma, Italy; e-mail: leofuso@rm.unicatt.it



Chest. 2002;121(2):443-451. doi:10.1378/chest.121.2.443
Text Size: A A A
Published online

Study objective: To verify whether autonomic neuropathy (AN) complicating type I, insulin-dependent diabetes mellitus affected neuroadrenergic bronchopulmonary innervation.

Patients: Twenty nonsmoking diabetic patients without respiratory diseases were studied: 11 patients with AN (group AN) and 9 patients without AN (control; group C) diagnosed by standardized criteria.

Design: Patients underwent respiratory function tests and ventilatory scintigraphies with 123I-metaiodobenzylguanidine (MIBG) and with 99mTc-diethylenetriaminepenta-acetic acid (DTPA) to assess both bronchopulmonary neuroadrenergic innervation and also permeability of the alveolar-capillary barrier to water-soluble tracers. Rates of pulmonary clearance of the two tracers were computed, and correlates were identified by nonparametric statistics.

Setting: University hospital.

Results: The AN and C groups had normal respiratory function test results and comparable duration of diabetes and quality of metabolic control. 99mTc-DTPA clearance did not distinguish the groups. 123I-MIBG clearance was faster in the AN group than in the C group (mean ± SD half-time of the radiotracer time-activity curve [T1/2], 116.1 ± 22.8 min in the AN group vs 139.5 ± 18.3 min in the C group, p = 0.022), which is consistent with neuroadrenergic denervation in the AN group. 123I-MIBG clearance was independent from 99mTc-DTPA clearance. Faster 123I-MIBG clearance was significantly associated with worse performance in three of the four autonomic tests.

Conclusions: Neuroadrenergic bronchopulmonary denervation may occur in diabetic patients with AN despite normal clinical and respiratory function findings. Further research is needed to identify clinical and prognostic implications of these findings.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543