库欣综合征中的葡萄糖代谢。
Glucose metabolism in Cushing's syndrome.
机构信息
Division of Diabetes and Endocrinology, University of Utah School of Medicine, Salt Lake City, Utah.
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo College of Medicine, Rochester, Minnesota, USA.
出版信息
Curr Opin Endocrinol Diabetes Obes. 2020 Jun;27(3):140-145. doi: 10.1097/MED.0000000000000537.
PURPOSE OF REVIEW
Impairment of glucose metabolism is commonly encountered in Cushing's syndrome. It is the source of significant morbidity and mortality even after successful treatment of Cushing's. This review is to understand the recent advances in understanding the pathophysiology of diabetes mellitus from excess cortisol.
RECENT FINDINGS
In-vitro studies have led to significant advancement in understanding the molecular effects of cortisol on glucose metabolism. Some of these findings have been translated with human data. There is marked reduction in insulin action and glucose disposal with a concomitant, insufficient increase in insulin secretion. Cortisol has a varied effect on adipose tissue, with increased lipolysis in subcutaneous adipose tissue in the extremities, and increased lipogenesis in visceral and subcutaneous truncal adipose tissue.
SUMMARY
Cushing's syndrome results in marked impairment in insulin action and glucose disposal resulting in hyperglycemia. Further studies are required to understand the effect on incretin secretion and action, gastric emptying, and its varied effect on adipose tissue.
目的综述
库欣综合征患者常伴有葡萄糖代谢紊乱。即使库欣综合征得到成功治疗，这种代谢紊乱仍会导致严重的发病率和死亡率。本文旨在了解皮质醇过量导致糖尿病发病机制的最新研究进展。
最近的发现
体外研究使我们对皮质醇对葡萄糖代谢的分子作用有了更深入的理解。其中一些发现已经通过人体数据得到了验证。皮质醇会显著降低胰岛素的作用和葡萄糖的摄取，同时胰岛素分泌不足。皮质醇对脂肪组织的影响也各不相同，四肢皮下脂肪组织的脂肪分解增加，内脏和皮下躯干脂肪组织的脂肪生成增加。
总结
库欣综合征会导致胰岛素作用和葡萄糖摄取明显受损，从而导致高血糖。还需要进一步研究以了解其对肠促胰岛素分泌和作用、胃排空以及对脂肪组织的不同影响。
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