Bizzarri C, Bottaro G, Pinto R M, Cappa M
Pediatr Endocrinol Rev. 2014 Jun;11(4):365-73.
The survival of children with cancer has grown considerably in recent years resulting in a marked increase of endocrine complications. increasingly recognized problems are metabolic syndrome and diabetes mellitus.
We critically analysed the most recent literature about the prevalence and molecular mechanisms of metabolic dysregulation and long-term cardio-metabolic risk in this population.
Hypothalamic irradiation determines growth hormone deficiency and hypogonadism; moreover it is able to disrupt the appetite regulating centre leading to hyperphagia and progressive obesity. These conditions determine an insulin resistant state, contributing to the development of metabolic syndrome and diabetes mellitus. Irradiation and/or chemotherapy may lead to an insulin secretory defect through a direct damage of pancreatic beta cells.
Metabolic syndrome and diabetes mellitus represent increasingly recognized long-term complications of childhood cancer treatment. The different impact of insulin resistance and secretory defects on the onset and progression of metabolic syndrome and diabetes mellitus remains unclear.
近年来，癌症患儿的生存率显著提高，导致内分泌并发症明显增加。越来越被认识到的问题是代谢综合征和糖尿病。
我们严格分析了关于该人群代谢失调患病率和分子机制以及长期心脏代谢风险的最新文献。
下丘脑照射会导致生长激素缺乏和性腺功能减退；此外，它还会破坏食欲调节中枢，导致食欲亢进和进行性肥胖。这些情况会导致胰岛素抵抗状态，促进代谢综合征和糖尿病的发展。照射和/或化疗可能通过直接损伤胰腺β细胞导致胰岛素分泌缺陷。
代谢综合征和糖尿病是儿童癌症治疗中越来越被认识到的长期并发症。胰岛素抵抗和分泌缺陷对代谢综合征和糖尿病的发生及进展的不同影响仍不清楚。
