Esposito Daniela, Boguszewski Cesar Luiz, Colao Annamaria, Fleseriu Maria, Gatto Federico, Jørgensen Jens Otto Lunde, Ragnarsson Oskar, Ferone Diego, Johannsson Gudmundur
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition), Sahlgrenska University Hospital, Gothenburg, Sweden.
Nat Rev Endocrinol. 2024 Sep;20(9):541-552. doi: 10.1038/s41574-024-00993-x. Epub 2024 Jun 6.
Acromegaly is a rare endocrine disease caused by hypersecretion of growth hormone, most commonly arising due to a pituitary adenoma. Diabetes mellitus is a common complication of acromegaly, occurring in approximately one-third of patients. The risk of diabetes mellitus in acromegaly is driven by increased exposure to growth hormone, which directly attenuates insulin signalling and stimulates lipolysis, leading to decreased glucose uptake in peripheral tissues. Acromegaly is a unique human model, where insulin resistance occurs independently of obesity and is paradoxically associated with a lean phenotype and reduced body adipose tissue mass. Diabetes mellitus in patients with acromegaly is associated with an increased risk of cardiovascular morbidity and mortality. Therefore, preventive measures and optimized treatment of diabetes mellitus are essential in these patients. However, specific recommendations for the management of diabetes mellitus secondary to acromegaly are lacking due to limited research on this subject. This Review explores the underlying mechanisms for diabetes mellitus in acromegaly and its effect on morbidity and mortality. We also discuss treatment modalities for diabetes mellitus that are suited for patients with acromegaly. Improved understanding of these issues will lead to better management of acromegaly and its associated metabolic complications.
肢端肥大症是一种由生长激素分泌过多引起的罕见内分泌疾病，最常见的病因是垂体腺瘤。糖尿病是肢端肥大症的常见并发症，约三分之一的患者会出现。肢端肥大症患者患糖尿病的风险是由于生长激素暴露增加所致，生长激素直接减弱胰岛素信号传导并刺激脂肪分解，导致外周组织葡萄糖摄取减少。肢端肥大症是一种独特的人类模型，胰岛素抵抗独立于肥胖发生，并且反常地与瘦体型和身体脂肪组织量减少相关。肢端肥大症患者的糖尿病与心血管疾病发病率和死亡率增加有关。因此，对这些患者而言，糖尿病的预防措施和优化治疗至关重要。然而，由于对此主题的研究有限，缺乏针对肢端肥大症继发糖尿病管理的具体建议。本综述探讨了肢端肥大症中糖尿病的潜在机制及其对发病率和死亡率的影响。我们还讨论了适合肢端肥大症患者的糖尿病治疗方式。对这些问题的更好理解将有助于更好地管理肢端肥大症及其相关的代谢并发症。
