Endocrinology Unit, Department of Medicine, DIMED, University of Padova, Via Ospedale 105, 35128 Padua, Italy.
Department of Cell Physiology & Metabolism, Centre Médical Universitaire, 1 Rue Michel Servet, 1211 Genèva, Switzerland.
Endocr Rev. 2017 Jun 1;38(3):189-219. doi: 10.1210/er.2016-1105.
An impaired glucose metabolism, which often leads to the onset of diabetes mellitus (DM), is a common complication of chronic exposure to exogenous and endogenous glucocorticoid (GC) excess and plays an important part in contributing to morbidity and mortality in patients with Cushing syndrome (CS). This article reviews the pathogenesis, epidemiology, diagnosis, and management of changes in glucose metabolism associated with hypercortisolism, addressing both the pathophysiological aspects and the clinical and therapeutic implications. Chronic hypercortisolism may have pleiotropic effects on all major peripheral tissues governing glucose homeostasis. Adding further complexity, both genomic and nongenomic mechanisms are directly induced by GCs in a context-specific and cell-/organ-dependent manner. In this paper, the discussion focuses on established and potential pathologic molecular mechanisms that are induced by chronically excessive circulating levels of GCs and affect glucose homeostasis in various tissues. The management of patients with CS and DM includes treating their hyperglycemia and correcting their GC excess. The effects on glycemic control of various medical therapies for CS are reviewed in this paper. The association between DM and subclinical CS and the role of screening for CS in diabetic patients are also discussed.
葡萄糖代谢受损，常导致糖尿病（DM）的发生，是慢性暴露于外源性和内源性糖皮质激素（GC）过多的常见并发症，在库欣综合征（CS）患者的发病率和死亡率中起着重要作用。本文综述了与皮质醇过多相关的葡萄糖代谢变化的发病机制、流行病学、诊断和管理，涉及病理生理方面以及临床和治疗意义。慢性高皮质醇血症可能对所有控制葡萄糖稳态的主要外周组织具有多效性影响。此外，基因组和非基因组机制都可以通过 GC 以特定于上下文和细胞/组织依赖性的方式直接诱导。本文的讨论重点是由循环中 GC 水平长期过度引起的、影响各种组织葡萄糖稳态的已确立和潜在的病理性分子机制。CS 和 DM 患者的管理包括治疗其高血糖和纠正 GC 过多。本文还回顾了各种 CS 治疗方法对血糖控制的影响。本文还讨论了 DM 与亚临床 CS 的关系以及在糖尿病患者中筛查 CS 的作用。
