DIABETES STEROID

From Big Medical Encyclopedia

DIABETES STEROID (grech, diabetes, from diabaino to pass through; a steroid[s]) — the clinical form of diabetes developing as a result of the excess content in blood for a long time of adrenal hormones or treatment by drugs of these hormones.

The etiology

Endogenous D. of page arises at the diseases caused by excess activity of AKTG and a secondary hypercorticoidism or primary hypercorticoidism (see. Adrenal glands, pathology ), connected with kortikosteromy.

Exogenous D. of page arises at prolonged treatment by drugs of glucocorticoids of patients with a pseudorheumatism, bronchial asthma, collagenoses, etc.

the Pathogeny

for the purpose of studying of a disease at people the pilot model of D. of page on animals by introduction of a cortisone by it was created. At the rabbits receiving a cortisone in basphilic insulotsita degranulation was noted and numerous mitoses were found; further these signs of activation of the insulyarny device were replaced by destructive changes. D.'s transition by the village to pancreatic diabetes was repeatedly noted also in clinic.

Impacts of glucocorticoids on protein and carbohydrate metabolism are the cornerstone of the mechanism of development of D. of page. They strengthen disintegration of proteins and slow down their synthesis. At the increased release of amino acids from fabrics and receipt them in a liver process of interamination, further deaminations of amino acids which are used for processes of a gluconeogenesis considerably accelerates. In a liver adjournment of a glycogen increases. Increase in release of nitrogen with urine under the influence of glucocorticoids specifies that a source of the described disturbances is disintegration of proteins. Impact of glucocorticoids on carbohydrate metabolism is shown by strengthening of activity of glyukozo-@-phosphatase and braking of activity of a glucokinase of a liver. The anti-insulin effect of steroids on the periphery is shown by reduction of utilization of glucose fabrics. Glucocorticoids strengthen a lipogenesis. Anti-ketogenic properties of glucocorticoids are connected with oppression of oxidation pyroracemic to - you, increase in blood milk to from here - you (see. Glucocorticoid hormones ).

The clinical picture

D. page is characterized by stable and rather high-quality current. Polydipsia (see) and polyuria (see) are expressed moderately, and sometimes are absent. Weight loss usually is not noted. Hyperglycemia (see) and glycosuria (see) seldom reach high figures. Patients note weakness, the fatigue caused by disturbance of use of carbohydrates fabrics and the increased disintegration of proteins. Acetonemia (see) and acidosis (see) are observed seldom. As a rule, the symptoms inherent to a hypercorticoidism are noted. Patients with D. of page, especially exogenous origin, have a relative resistance to insulin. In these cases the diet with restriction of carbohydrates is effective.

The diagnosis

the Diagnosis is based on emergence of a hyperglycemia and glycosuria at patients with an endogenous or exogenous giperkortipizm (the increased content in blood 17 of ketosteroids and 17 oxycorticosteroids and their excretion with urine). In the presence at patients of a normal sugar content of blood on an empty stomach with test for tolerance to glucose it is possible to reveal a latent diabetes mellitus.

Treatment

Treatment shall be directed to elimination of the reason of a hypercorticoidism. So, bilateral adrenalectomy (see) at a hyperplasia of bark of adrenal glands or removal kortikosteroma (see) improves D.'s current of page up to normalization of a sugar content in blood. At an exogenous hypercorticoidism the urgent termination of introduction of glucocorticoids is necessary. A symptomatic treatment — a diet, purpose of orally antihyperglycemic means and an insulin therapy. The choice of a method of treatment and a dosage of insulin and peroral glucose-lowering drugs are defined by degree of a glycemia and a glycosuria. At diseases where purpose of glucocorticoids was carried out according to vital indications (collagenoses, a pemphigus, etc.), are limited to a symptomatic treatment.

The forecast

the Forecast at endogenous D. of page depends on efficiency of treatment of a basic disease, at exogenous — on timely cancellation of treatment by glucocorticoids. At a long current of D. of page can pass into a diabetes mellitus (see. diabetes mellitus ).


Bibliography: Diabetes, under the editorship of R. Williams, the lane with English, page 548, M., 1964, bibliogr.; The multivolume guide to internal diseases, under the editorship of E. M. Tareeva, t. 7, L., 1966, bibliogr.; A diabetes mellitus, under the editorship of V. R. Klyachko, M., 1974; With about f-f e r L., D about r f m and R.'s N and of e r silt and in L. Epinephral glands of the person, the lane with English, page 124, M., 1966; Cam r-b e of 1 1 J. and. lake of Diabetogenic effect of purified growth hormone, Endocrinology, v. 46, p. 273, 1950; Diabetes, mellitus, theory and practice, ed. by M. Ellenberg a. H. Rifkin, N. Y., 1970; Diabetes mellitus, hrsg. y. H. Bibergeil u. W. Bruns, Jena, 1974.

A.S. Yefimov.

Яндекс.Метрика