Female reproduction and type 1 diabetes: from mechanisms to clinical findings

被引:141
作者
Codner, E. [1 ]
Merino, P. M. [1 ,2 ]
Tena-Sempere, M. [3 ,4 ,5 ]
机构
[1] Univ Chile, Inst Maternal & Child Res IDIMI, Sch Med, Santiago, Chile
[2] Univ Chile, Sch Med, Dept Paediat, Santiago 8360160, Chile
[3] Univ Cordoba, Dept Cell Biol Physiol & Immunol, Cordoba, Spain
[4] Inst Salud Carlos III, CIBER Fisiopatol Obesidad & Nutr, Madrid, Spain
[5] Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed IMIBIC, Cordoba 14004, Spain
关键词
type 1 diabetes mellitus; fertility; puberty; menopause; ovary; GONADOTROPIN-RELEASING-HORMONE; POLYCYSTIC-OVARY-SYNDROME; ANTI-MULLERIAN HORMONE; HYPOTHALAMIC KISS-1 SYSTEM; GLYCATION END-PRODUCTS; GROWTH-FACTOR-I; SERUM LEPTIN CONCENTRATIONS; POPULATION-BASED COHORT; POOR GLYCEMIC CONTROL; INHIBIN B LEVELS;
D O I
10.1093/humupd/dms024
中图分类号
R71 [妇产科学];
学科分类号
100211 [妇产科学];
摘要
The functional reproductive alterations seen in women with type 1 diabetes (T1D) have changed as therapy has improved. Historically, patients with T1D and insufficient metabolic control exhibited a high prevalence of amenorrhea, hypogonadism and infertility. This paper reviews the impact of diabetes on the reproductive axis of female T1D patients treated with modern insulin therapy, with special attention to the mechanisms by which diabetes disrupts hypothalamicpituitaryovarian function, as documented mainly by animal model studies. A comprehensive MEDLINE search of articles published from 1966 to 2012 was performed. Animal model studies on experimental diabetes and human studies on T1D were examined and cross-referenced with terms that referred to different aspects of the gonadotropic axis, gonadotrophins and gonadal steroids. Recent studies have shown that women with T1D still display delayed puberty and menarche, menstrual irregularities (especially oligomenorrhoea), mild hyperandrogenism, polycystic ovarian syndrome, fewer live born children and possibly earlier menopause. Animal models have helped us to decipher the underlying basis of these conditions and have highlighted the variable contributions of defective leptin, insulin and kisspeptin signalling to the mechanisms of perturbed reproduction in T1D. Despite improvements in insulin therapy, T1D patients still suffer many reproductive problems that warrant specific diagnoses and therapeutic management. Similar to other states of metabolic stress, T1D represents a challenge to the correct functioning of the reproductive axis.
引用
收藏
页码:568 / 585
页数:18
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