DIABETES MELLITUS IN NEUROENDOCRINE DISEASES

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Abstract

There are many endocrine diseases accompanied by development of secondary diabetes mellitus (sDM). The features of the development and course of sDM in acromegaly, Cushing’s syndrome, and growth hormone (GH) deficiency are of particular interest as the prevalence of sDM associated with these pathologies is higher than that in the population. The main risk factors for sDM in acromegaly are age, female gender, arterial hypertension, family history of type 2 DM (T2DM), acromegaly activity, and duration and certain treatment methods of acromegaly. The differences of the sDM pathogenesis from pathogenesis of T2DM in the population are due to the opposite effect of GH and insulin-like growth factor 1 on glucose metabolism as well as to effect of acromegaly treatment on the mechanisms of diabetes development. The prevalence of diabetes in patients with GH deficiency, especially against the background of GH replacement therapy, is slightly higher than that in population. However, some studies have shown that GH replacement therapy may lead to normalization of the impaired glucose metabolism. High prevalence of metabolic syndrome (43%) and visceral obesity in the GH deficiency are the causes of the development of lipotoxicity (free fatty acids excess) and insulin resistance.In Cushing’s syndrome, the prevalence of early carbohydrate metabolism disturbances may reach 70%. In Cushing’s disease, chronic glucocorticoid excess determines insulin resistance and reduces insulin secretion, which results in hyperglycaemia. Currently, the recommendations for the treatment of sDM in acromegaly, hypercortisolism, and GH deficiency are the same as for the treatment of T2DM. However, as the pathogenesis is different in sDM and T2DM, the new algorithms for the diagnosis, prevention and treatment need to be developed. Prevention and timely treatment based on pathological principals will slow down the development of micro- and macrovascular complications leading to early disability and death of patients with neuroendocrine diseases.

About the authors

I. V. Trigolosova

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Author for correspondence.
Email: trigolosova_ira@mail.ru
PhD, senior scientific worker, Department of Therapeutic Endocrinology, MONIKI Russian Federation

A. V. Vinogradova

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Email: fake@neicon.ru
MD, physician-endocrinologist, Department of Therapeutic Endocrinology, MONIKI Russian Federation

M. V. Kruglyakova

Municipal Hospital No.3 of the Moscow Department of the Ministry of Public Health; 2/1 Kashtanovaya alleya, Zelenograd, 124489, Russian Federation

Email: fake@neicon.ru

MD, physician-endocrinologist, Consulting-and-Diagnostic Department, Municipal Hospital No.3, Zelenograd

Russian Federation

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