Codner Ethel, Cassorla Fernando
Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
Horm Res. 2009 Jan;71(1):12-21. doi: 10.1159/000173737. Epub 2008 Nov 27.
Insulin is well known for its effects on carbohydrate metabolism, but this hormone also plays an important role in regulating ovarian function. Granulosa, theca and stromal ovarian cells may be affected by insulin deficiency or excess, which may be present in women with type 1 diabetes mellitus (T1D). Recent publications have shown that in spite of intensive insulin therapy, some delay in the age of thelarche, pubarche and menarche is still observed in girls with T1D. In addition, ovarian hyperandrogenism may be observed during late adolescence and an increased prevalence of hirsutism and polycystic ovarian syndrome (PCOS) has been described in adult women with T1D. These endocrine abnormalities may be related to nonphysiologic insulin replacement therapy and to hyperglycemia. This paper reviews the pubertal development and the clinical reproductive abnormalities observed in girls with type 1 diabetes mellitus, and shows that several significant clinical problems, such as pubertal delay, menstrual disturbances and hyperandrogenism which may ultimately lead to the development of PCOS in adulthood, may be observed in some of these patients.
胰岛素因其对碳水化合物代谢的作用而广为人知，但这种激素在调节卵巢功能方面也起着重要作用。颗粒细胞、卵泡膜细胞和卵巢基质细胞可能会受到胰岛素缺乏或过量的影响，1型糖尿病（T1D）女性体内可能存在这种情况。最近的出版物表明，尽管进行了强化胰岛素治疗，但在患有T1D的女孩中，仍观察到乳房发育、阴毛生长和月经初潮的年龄有所延迟。此外，在青春期后期可能会出现卵巢雄激素过多症，并且在患有T1D的成年女性中，多毛症和多囊卵巢综合征（PCOS）的患病率有所增加。这些内分泌异常可能与非生理性胰岛素替代治疗和高血糖有关。本文综述了1型糖尿病女孩的青春期发育和观察到的临床生殖异常情况，并表明在其中一些患者中可能会观察到一些重大临床问题，如青春期延迟、月经紊乱和雄激素过多症，这些问题最终可能导致成年期PCOS的发生。
