21-羟化酶缺乏所致非经典型先天性肾上腺皮质增生症女性的高胰岛素血症和胰岛素抵抗：血清瘦素水平与慢性高胰岛素血症之间的关系

Hyperinsulinemia and insulin insensitivity in women with nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency: the relationship between serum leptin levels and chronic hyperinsulinemia.

作者信息

Saygili F, Oge A, Yilmaz C

机构信息

Division of Endocrinology and Metabolism, Ege University, School of Medicine, Izmir, Turkey.

出版信息

Horm Res. 2005;63(6):270-4. doi: 10.1159/000086363. Epub 2005 Jun 13.

DOI:10.1159/000086363

PMID:15956788

Abstract

BACKGROUND/AIM: Nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (NC-CAH) is associated with hyperandrogenemia, chronic anovulation, hirsutism, acne and adrenal hyperplasia. A few studies have shown hyperinsulinemia and insulin insensitivity in NC-CAH. Hyperinsulinemia can stimulate leptin secretion, and androgens can inhibit leptin secretion. Thus, we designed a study to investigate the insulin levels and insulin sensitivity and the effect of chronic endogenous hyperinsulinemia and androgens on leptin in patients with NC-CAH.

METHODS

Eighteen women with untreated NC-CAH and 26 normally cycling control women with a similar body mass index (BMI) were studied. Basal hormones, fasted and fed insulin levels, leptin and stimulated 17-hydroxyprogesterone (17-OHP) concentrations were studied. Homeostasis model assessment was used to assess insulin sensitivity.

RESULTS

The basal 17-OHP, the free testosterone (fT) and dehydroepiandrosterone sulfate (DHEA-S) were significantly different in the 2 groups (p < 0.05). Fasting and fed insulin levels of the NC-CAH group were higher than those of the control group (p < 0.05) and insulin sensitivity was lower in NC-CAH than in controls (p < 0.05). Insulin levels were correlated with fT and 17-OHP (p < 0.05). Serum leptin levels for NC-CAH (25.9 +/- 12.5 microg/l) did not differ from the controls (25.4 +/- 12.06 microg/l) and were positively correlated with BMI (r = 0.725) and percent body fat (r = 0.710) for both groups (both p < 0.001). Leptin levels were not correlated with estrogen or androgens, gonadotropins or insulin levels.

CONCLUSION

Hyperinsulinemia and insulin insensitivity associated with hyperandrogenism were detected in untreated NC-CAH patients as in previous reports, whereas serum leptin levels did not differ from those of controls.

摘要

背景/目的：21-羟化酶缺乏所致非经典型先天性肾上腺皮质增生症（NC-CAH）与高雄激素血症、慢性无排卵、多毛、痤疮及肾上腺增生相关。一些研究显示NC-CAH患者存在高胰岛素血症及胰岛素抵抗。高胰岛素血症可刺激瘦素分泌，而雄激素可抑制瘦素分泌。因此，我们设计了一项研究，以调查NC-CAH患者的胰岛素水平及胰岛素敏感性，以及慢性内源性高胰岛素血症和雄激素对瘦素的影响。

方法

对18例未经治疗的NC-CAH女性患者及26例体重指数（BMI）相近的正常月经周期对照女性进行研究。检测基础激素、空腹及餐后胰岛素水平、瘦素及刺激后的17-羟孕酮（17-OHP）浓度。采用稳态模型评估法评估胰岛素敏感性。

结果

两组患者的基础17-OHP、游离睾酮（fT）及硫酸脱氢表雄酮（DHEA-S）存在显著差异（p < 0.05）。NC-CAH组患者的空腹及餐后胰岛素水平高于对照组（p < 0.05），且NC-CAH组的胰岛素敏感性低于对照组（p < 0.05）。胰岛素水平与fT及17-OHP相关（p < 0.05）。NC-CAH组患者的血清瘦素水平（25.9±12.5μg/l）与对照组（25.4±12.06μg/l）无差异，且两组患者的瘦素水平均与BMI（r = 0.725）及体脂百分比（r = 0.710）呈正相关（均p < 0.001）。瘦素水平与雌激素、雄激素、促性腺激素或胰岛素水平无关。