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Hypertension, dyslipidemias, glucose intolerance and obesity are among the most important cardiovascular risk factors. There is growing evidence for the concept of a relationship between blood pressure regulation and metabolic changes. The combination of hypertension and the metabolic changes mentioned above has been named metabolic syndrome in the literature. The central role of insulin resistance and consecutive hyperinsulinemia in the metabolic syndrome has been shown in epidemiological, clinical, genetic and animal studies. The metabolic syndrome can be demonstrated in about one half of the hypertensive population. This pathophysiological concept has to be taken into consideration in the therapy and prevention of the different cardiovascular risk factors.

The pathology of insulinoma and gastrinoma was studied in 81 patients (31 men, 50 women, mean age 48.4 years) suffering from persistent hyperinsulinaemic hypoglycaemia, and in 44 patients (28 men, 16 women, mean age 48.5 years) with Zollinger-Ellison syndrome. Insulinomas were seen in the pancreas of all patients with persistent hyperinsulinaemic hypoglycaemia. In 70 of the 81 patients the insulinoma was solitary, whereas six patients had multiple insulinomas. In five patients with multiple endocrine neoplasia type I, multiple endocrine tumours of the pancreas were visible, only one of them in each case being an insulinoma. 75% of all insulinomas were less than 2 cm in size and 15% were malignant. 18 of the 44 Zollinger-Ellison syndrome patients also had multiple endocrine neoplasia type I. Nine of these patients presented with duodenal gastrinomas which were often multiple and smaller than 0.5 cm. The gastrinoma was located in the pancreas of one of the patients with multiple endocrine neoplasia, in two patients in lymph nodes, and no gastrinoma was identified in the specimens from six patients. 33% of the duodenal gastrinomas had metastasised. Solitary gastrinomas were found in all 26 patients with sporadic Zollinger-Ellison syndrome, 14 being located in the pancreas (diameter over 2 cm in eight cases) and ten in the duodenum (diameter less than 1 cm in seven cases). 16 of these gastrinomas were malignant.

Six to ten days after conversion from usual alimentary habits to a so-called "reasonable" regimen, the serum concentrations of different lipid fractions were examined under standardized conditions, in a total of 325 in-patients, who had not been pre-treated, and 268 of whom showed - after diverse examinations - a hyperlipoproteinaemia; the other 57 patients had normal lipid values. This diet food is vitamin-rich, poor in calories, protein-rich with a 20 per cent to 25 per cent part of calories, poor in carbohydrates (maximum 120 g/day), and extensively renouncing monomeric and dimeric carbohydrates; furthermore, it contains a percentage of 40 to 45 calories of lipids with a standardized part of multiple-unsaturated fatty acids. During the period of observation, there was in none of the patients an alteration of the body-weight exceeding 1 kg. During the period of the regimen, the following highly significant decreases - without any medicamentous measures - were stated with regard to the serum concentrations: Total cholesterol (average) 9.9 per cent, triglycerides (average) 23.1 per cent, beta-cholesterol (average) 17.6 per cent, and phosphatides (average) 14.2 per cent - all percentages being in relation to the reference values. A hyperproteinaemia (type IIa/Fredrickson) disappeared in 14 out of 18 cases, a hyperlipoproteinaemia (type IIb) in 14 out of 44 cases, and the same happened with this disease type IV in 114 out of 206 cases. A change of type was stated 16 times.

The influence of fetal hyperinsulinemia on the development of diabetic fetopathy was investigated. Human fetal pancreatic slices of fetus between the 12th and 26th weeks of pregnancy from non diabetic (n = 32) and diabetic (n = 18) women were incubated in vitro for one hour. The insulin secretion results clearly demonstrate an age dependent increase in both groups investigated, but the increase is much more pronounced in fetuses from diabetic women. The differences between the groups are present already during the 12th week of pregnancy. The results support the concept to normalize the metabolic control in pregnancy as early as possible in order to prevent the diabetic fetopathy.

In altogether 31 patients with liver cirrhosis, fatty degeneration of the liver or a morphologically normal liver the free fatty acids, glycerin, ketone bodies and triglycerides were examined as parameters of the fat metabolism after nocturnal alimentary abstinence and under 2-hour glucose infusion. Parallel to this estimations of the immune-reactive insulin and of the blood glucose were performed. In liver cirrhoses increased levels of free fatty acids, low ketone body levels, the absent correlation between ketone bodies and immune-reactive insulin under basis conditions as well as the relatively smaller reduction of the TG-values in hyperinsulinaemia were to be established. They may be explained as an expression of restricted metabolic functions of the cirrhotic liver. On the other hand from the prompt decrease of free fatty acids and glycerin under glucose-induced hyperinsulinaemia was concluded to an unrestricted efficacy of the insulin in the fatty tissue in the sense of the furthering of lipogenesis and inhibition of the lipolysis.