Metabolic complications of androgen deprivation therapy for prostate cancer.
Metabolic complications of androgen deprivation therapy for prostate cancer.
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DOI：
10.1016/j.juro.2009.01.047
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Smith MR
中科院分区：
文献类型：
--
作者：
Saylor PJ;Smith MR
雄激素剥夺疗法具有各种公认的不良反应，包括血管潮红、性欲丧失、疲劳、男性乳房发育、贫血和骨质疏松症。本文综述了雄激素剥夺治疗的代谢并发症，包括肥胖，胰岛素抵抗和脂质改变，以及雄激素剥夺治疗与糖尿病和心血管疾病的关联。我们使用PubMed®检索词前列腺癌、雄激素剥夺治疗、促性腺激素释放激素激动剂、肥胖、胰岛素抵抗、血脂、糖尿病、心血管疾病和心肌梗死对医学文献进行了综述。我们提供了一个集中的审查和我们的观点的相关文献。雄激素剥夺疗法减少瘦体重和增加脂肪量。它还降低胰岛素敏感性，同时增加低密度脂蛋白胆固醇，高密度脂蛋白胆固醇和甘油三酯。与这些不良代谢作用一致，雄激素剥夺治疗可能与糖尿病和心血管疾病的发病率增加相关。其中一些雄激素剥夺治疗相关的代谢变化（肥胖、胰岛素抵抗和甘油三酯升高）与代谢综合征的特征重叠。然而，与代谢综合征相反，雄激素剥夺治疗增加皮下脂肪和高密度脂蛋白胆固醇。雄激素剥夺疗法增加肥胖，降低胰岛素敏感性，并不利地改变脂质分布。它可能与糖尿病和心血管疾病的发病率较高有关。雄激素剥夺治疗的好处应该与这些和其他潜在的危害相权衡。关于减轻雄激素剥夺治疗的不良代谢作用的最佳策略知之甚少。因此，我们建议强调现有的筛查和治疗策略，这些策略已被证明可以降低普通人群中糖尿病和心血管疾病的风险。
Androgen deprivation therapy has a variety of well recognized adverse effects including vasomotor flushing, loss of libido, fatigue, gynecomastia, anemia and osteoporosis. This review focuses on the more recently described metabolic complications of androgen deprivation therapy including obesity, insulin resistance and lipid alterations as well as the association of androgen deprivation therapy with diabetes and cardiovascular disease. We reviewed the medical literature using the PubMed® search terms prostate cancer, androgen deprivation therapy, gonadotropin-releasing hormone agonists, obesity, insulin resistance, lipids, diabetes, cardiovascular disease and myocardial infarction. We provide a focused review and our perspective on the relevant literature. Androgen deprivation therapy decreases lean mass and increases fat mass. It also decreases insulin sensitivity while increasing low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglycerides. Consistent with these adverse metabolic effects, androgen deprivation therapy may be associated with a greater incidence of diabetes and cardiovascular disease. Some of these androgen deprivation therapy related metabolic changes (obesity, insulin resistance and increased triglycerides) overlap with features of the metabolic syndrome. However, in contrast to the metabolic syndrome, androgen deprivation therapy increases subcutaneous fat and high density lipoprotein cholesterol. Androgen deprivation therapy increases obesity, decreases insulin sensitivity and adversely alters lipid profiles. It may be associated with a greater incidence of diabetes and cardiovascular disease. The benefits of androgen deprivation therapy should be weighed against these and other potential harms. Little is known about the optimal strategy to mitigate the adverse metabolic effects of androgen deprivation therapy. Thus, we recommend an emphasis on existing strategies for screening and treatment that have been documented to reduce the risk of diabetes and cardiovascular disease in the general population.
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