Steroid diabetes mellitus, sexual function in Itsenko-Cushing’s disease

Diseases of the stomach, ulcers in Cushing’s disease

The pathogenesis of steroid diabetes is explained as follows: insufficient protein resynthesis as a result of excess glucocorticoids leads to the formation of glucose from amino acids. Stimulation of glucose-6-phosphatase in the liver by these hormones promotes the release of glucose from this organ. In addition, glucocorticoids inhibit the activity of the enzyme hexokinase, which inhibits glucose metabolism.

The transition to overt diabetes mellitus can be observed in Itsenko-Cushing’s disease only when there is an inferior activity of the insular apparatus, i.e., on the foul of the so-called latent form of diabetes mellitus, or prediabetes. This form of diabetes usually proceeds without acidosis. After subtotal or total removal of the adrenal glands, diabetes usually disappears. 

Violation of sexual function in the clinical picture of the disease under study is quite prominent. With these disorders, in some cases, the disease begins. In women, there is hypotrophy of the uterus, mammary glands and amenorrhea; the ovaries are not altered or atrophic, sclerosed, sometimes cystically degenerated. An increase in the production of the follicle-stimulating hormone by the adipohypophysis was noted with the preservation of changes corresponding to the proliferative phase of the menstrual cycle. Vaginal smears in women at the onset of the disease can be hyperestrogenic, and in the late period hypoestrogenism occurs. 

Despite the fact that amenorrhea and infertility are characteristic signs of the disease, there is a description of isolated cases of pregnancy and childbirth against the background of remission of Itsenko-Cushing’s disease. In men, many authors note impotence that occurs already during the development of the first signs of the disease.  

In Itsenko-Cushing ‘s disease, inflammatory changes occur in the lungs, which are focal bronchopneumonia. The peculiarities of their course lie in the tendency to merge foci of inflammation and abscess formation. Pulmonary edema and hemorrhagic heart attacks in the lungs occur due to circulatory disorders. In patients, the function of the external respiration apparatus is often impaired, while the depth of respiration and the vital capacity of the lungs decrease. In some patients, respiratory failure is the basis of respiratory failure. 

Violation of the secretory function of the stomach in patients suffering from Itsenko-Cushing’s disease, is expressed in hypersecretion and a high content of uropepsin. Increased gastric hypersecretion disappears after adrenalectomy. 

Gastroduodenal ulcers in patients are relatively rare, their pathogenesis is in many ways different from the pathogenesis of ulcers that develop with steroid therapy. In Itsenko-Cushing’s disease, diffuse or limited edema of the mucous-submucous layer of the stomach is often expressed, which is apparently due to hemodynamic disorder and hormonal disorders. A number of authors found in patients hyperacid gastritis, which, apparently, is due to hypersecretion of corticosteroids. 

The liver is also involved in the pathological process in Itsenko-Cushing’s disease , which is manifested by a violation of its function; galactose-fixing, antitoxic, irothrombin-forming, cholesterol-forming. The total protein content is increased, the content of albumin is reduced, the number of γ-globulins is increased, the tendency to increase a1- and a2-globulins.

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