Escobar-Morreale H F, Roldán B, Barrio R, Alonso M, Sancho J, de la Calle H, García-Robles R
Department of Endocrinology, Hospital Ramón y Cajal, Madrid, Spain.
J Clin Endocrinol Metab. 2000 Nov;85(11):4182-7. doi: 10.1210/jcem.85.11.6931.
The current recommendation for strict metabolic control of type 1 diabetes mellitus requires the administration of supraphysiological doses of insulin, which might result in insulin-mediated stimulation of androgen synthesis, as occurs in insulin-resistant states. At present, the prevalence of hyperandrogenic disorders in women with type 1 diabetes mellitus is unknown. Eighty-five women with type 1 diabetes mellitus were evaluated for symptoms and signs of hyperandrogenism. In 68 of the patients, several serum androgen and hormone concentrations were measured. The polycystic ovary syndrome (PCOS) was defined by the presence of menstrual dysfunction, together with clinical and/or biochemical evidence of hyperandrogenism, and exclusion of other etiologies. Eighteen healthy women, menstruating regularly, served as controls for the androgenic profiles. Thirty-three patients (38.8%) presented hyperandrogenic disorders (16 had PCOS, and 17 had hirsutism without menstrual dysfunction). Type 1 diabetic patients with PCOS presented increased serum total and free testosterone concentrations, and serum androstenedione levels, but had normal serum sex hormone-binding globulin and dehydroepiandrosterone-sulfate levels. Hirsute type 1 diabetic women without menstrual dysfunction presented normal serum androgen levels. There were no significant differences between hyperandrogenic and nonhyperandrogenic type 1 diabetes mellitus women in clinical variables such as the duration of diabetes, age at diagnosis of diabetes, conventional or intensive insulin therapy, mean daily insulin dosage, or metabolic control. In conclusion, women with type 1 diabetes mellitus have a high prevalence of hyperandrogenic disorders, including PCOS and hirsutism.
目前对于1型糖尿病严格代谢控制的建议要求给予超生理剂量的胰岛素，这可能会导致胰岛素介导的雄激素合成刺激，就像在胰岛素抵抗状态下发生的那样。目前，1型糖尿病女性中高雄激素血症的患病率尚不清楚。对85名1型糖尿病女性进行了高雄激素血症症状和体征的评估。在68名患者中，测量了几种血清雄激素和激素浓度。多囊卵巢综合征（PCOS）的定义为存在月经功能障碍，以及高雄激素血症的临床和/或生化证据，并排除其他病因。18名月经规律的健康女性作为雄激素谱的对照。33名患者（38.8%）出现高雄激素血症（16例患有PCOS，17例有多毛症但无月经功能障碍）。患有PCOS的1型糖尿病患者血清总睾酮和游离睾酮浓度以及血清雄烯二酮水平升高，但血清性激素结合球蛋白和硫酸脱氢表雄酮水平正常。无月经功能障碍的多毛1型糖尿病女性血清雄激素水平正常。在糖尿病病程、糖尿病诊断年龄、常规或强化胰岛素治疗、平均每日胰岛素剂量或代谢控制等临床变量方面，高雄激素血症和非高雄激素血症的1型糖尿病女性之间没有显著差异。总之，1型糖尿病女性中高雄激素血症的患病率很高，包括PCOS和多毛症。
