Andrews R C, Walker B R
University of Edinburgh, Department of Medical Sciences, Western General Hospital, Edinburgh EH4 2XU, Scotland, U.K.
Clin Sci (Lond). 1999 May;96(5):513-23. doi: 10.1042/cs0960513.
Insulin resistance has been proposed as a mediator of the association between risk factors for cardiovascular disease in the population. The clinical syndrome of glucocorticoid excess (Cushing's syndrome) is associated with glucose intolerance, obesity and hypertension. By opposing the actions of insulin, glucocorticoids could contribute to insulin resistance and its association with other cardiovascular risk factors. In this review, we describe briefly the known mechanisms of insulin resistance and highlight the potential mechanisms for the effect of glucocorticoids. We then discuss factors which modulate the influence of glucocorticoids on insulin sensitivity; this highlights a novel therapeutic strategy to manipulate glucocorticoid action which may prove to be a useful tool in treating subjects with insulin resistance. Finally, we describe evidence from human studies that glucocorticoids make an important contribution to the pathophysiology of insulin resistance in the population.
胰岛素抵抗被认为是人群中心血管疾病危险因素之间关联的一个介导因素。糖皮质激素过多的临床综合征（库欣综合征）与葡萄糖不耐受、肥胖和高血压有关。通过对抗胰岛素的作用，糖皮质激素可能导致胰岛素抵抗及其与其他心血管危险因素的关联。在本综述中，我们简要描述了已知的胰岛素抵抗机制，并强调了糖皮质激素作用的潜在机制。然后我们讨论调节糖皮质激素对胰岛素敏感性影响的因素；这凸显了一种操纵糖皮质激素作用的新型治疗策略，这可能被证明是治疗胰岛素抵抗患者的有用工具。最后，我们描述了来自人体研究的证据，即糖皮质激素对人群中胰岛素抵抗的病理生理学有重要贡献。
