类固醇性糖尿病类固醇性糖尿病SteroiddiabetesSteroiddiabetes管庆波管庆波山东省立医院内分泌代谢科山东省立医院内分泌代谢科山东省内分泌代谢病临床医学中心山东省内分泌代谢病临床医学中心山东省临床医学研究院内分泌代谢病研究所山东省临床医学研究院内分泌代谢病研究所•概述•流行病学•机制•诊断•治疗History1855–Addison'sdisease1856–Adrenalglandsessentialforlife1930–Cortex>medulla1932–Cushing’ssyndrome1949–Henchetal(Steroidsinrheumatoidarthritis)1952–Aldosterone•Promotenormalintermediarymetabolism:GluconeogenesisStimulateproteincatabolismStimulatelipolysis•Increaseresistancetostressby:RaisingbloodglucoselevelModestriseinBP•Alterbloodcelllevelsinplasma:Decreaseineosinophils,basophils,monocytesandlymphocytesbyredistributionfromcirculationtolymphoidtissueIncreaseinthenumberofRBC,platelets,neutrophilsActionsofGlucocorticoids•Antiinflammatoryaction:(Complexmechanism)SuppressionofimmunityIndirectinhibitionofphospholipaseA2•Alterotherendocrinesystems:DecreaseinACTHandTSHIncreaseinGH•Effectsonothersystems:Increasedproductionofgastricacid,pepsinEffectsonCNSBonelossMyopathyActions…Cont.常用糖皮质激素剂量换算、作用、半衰期及效能药物等效剂量糖皮质激素作用抗炎效价钠潴留作用生物学半衰期（小时）—————————————————————————————————————低效可的松25mg0.828～128～36氢化可的松20mg11.0>28～12中效强的松5mg43.5112～26强的松龙5mg44.0112～36甲基强的松龙4mg55.0012～36去炎松4mg55.0012～36高效倍他米松0.6mg2530.003654AdverseeffectsPsychiatric•Sleepdisturbance/activation•Mooddisturbance•PsychosisSkin/softtissue•Cushingoidappearance•Abdominalstriae•Acne•Hirsutism•OedemaNeurologic•Neuropathy•PseudomotorcerebriCardiovascular•Hypertension•Occurwithprolongeduseofhighdoses•Cushing’sdiseaseMSK•Osteoporosis•Ascepticnecrosisofbone•MyopathyEndocrine•Diabetesmellitus•AdrenalcortexsuppressionImmunologic•Lymphocytopenia•Immunosuppression•False-negativeskintestOpthalmic•Cataract•Narrow-angleglaucomaDevelopmental•Growthretardation•糖皮质激素因其多...
