Rogowicz-Frontczak Anita, Majchrzak Anna, Zozulińska-Ziółkiewicz Dorota
Department of Internal Medicine and Diabetology, Poznan University of Medical Science, Poland.
Endokrynol Pol. 2017;68(3):334-351. doi: 10.5603/EP.2017.0026.
Changes in sensitivity to insulin occur in the course of a number of endocrine disorders. Most of the hormones through their antagonistic action to insulin lead to increased hepatic glucose output and its decreased utilisation in peripheral tissues. Carbohydrate disorders observed in endocrine diseases result from the phenomenon of insulin resistance, and in some cases also a reduction in insulin secretion is present. Abnormalities of glucose metabolism are observed in acromegaly, but also in growth hormone deficiency, hypercortisolism in the course of Cushing's syndrome, hyper- or hypothyroidism, primary hyperparathyroidism, aldosteronism, pheochromocytoma, congenital hypertrophy of the adrenal glands, polycystic ovaries syndrome, hypogonadism, or other hormonally active neuroendocrine tumours. They are of a secondary nature in relation to impaired hormonal balance. Hyperglycaemia is therefore often reversible, and the most effective method of treatment of impaired insulin sensitivity is successful therapy of specific endocrinopathies. Insulin sensitisers, also with a good effect, are used. Most experiences to date can be attributed to metformin therapy. Attempts have been made at treatment with other agents that are also effective in reducing insulin resistance as incretins or glitazones. In the presented paper, the authors reviewed endocrine diseases in which there is a clinically significant change in insulin sensitivity. Moreover, methods of therapy of concomitant disturbed glucose metabolism were presented.
在许多内分泌疾病过程中会出现对胰岛素敏感性的变化。大多数激素通过其对胰岛素的拮抗作用导致肝脏葡萄糖输出增加，而其在周围组织中的利用率降低。内分泌疾病中观察到的碳水化合物紊乱是由胰岛素抵抗现象引起的，在某些情况下还存在胰岛素分泌减少。在肢端肥大症中可观察到葡萄糖代谢异常，在生长激素缺乏症、库欣综合征过程中的皮质醇增多症、甲状腺功能亢进或减退、原发性甲状旁腺功能亢进、醛固酮增多症、嗜铬细胞瘤、先天性肾上腺皮质增生、多囊卵巢综合征、性腺功能减退或其他激素活性神经内分泌肿瘤中也可观察到。它们相对于激素平衡受损而言具有继发性。因此，高血糖通常是可逆的，治疗胰岛素敏感性受损的最有效方法是成功治疗特定的内分泌疾病。也会使用具有良好效果的胰岛素增敏剂。迄今为止，大多数经验都可归因于二甲双胍治疗。人们尝试用其他在降低胰岛素抵抗方面也有效的药物进行治疗，如肠促胰岛素或格列酮类药物。在本文中，作者回顾了胰岛素敏感性有临床显著变化的内分泌疾病。此外，还介绍了伴随的葡萄糖代谢紊乱的治疗方法。
