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*For medical professionals only, refer to
diabetes "remission", be wary!
Diabetes is a lifelong disease, and generally only a small number of mild type 2 diabetes patients can achieve "clinical remission" through early "intensive insulin therapy", that is, patients do not need to inject insulin or take hypoglycemic drugs, and rely solely on diet control and exercise therapy to maintain normal
blood sugar.
twice a day.
Although Mr.
Zhang has controlled his blood sugar well over the years, he knows
it bitterly.
Teacher Zhang often pours bitter water on his neighbors: "How good it would be if we could cure diabetes, stop taking injections and medicines every day, eat whatever you want, and don't have to worry about blood sugar rising!" "
Unexpectedly, Teacher Zhang's wish really came true not long ago!
After the Spring Festival this year, she often felt flustered, sweating, hunger, and her blood sugar was low for many times.
The diabetes that has plagued Teacher Zhang for many years is finally "good", it stands to reason that Teacher Zhang should be happy, but on the contrary, Teacher Zhang, who has always been crisp and neat, quick to talk, is like a changed person, listless all day, silent, not thinking about eating, fatigue and lethargy, and the personality is particularly afraid of cold, Yangchun March is still wearing thick cotton clothes at home, and his face looks a little swollen and sallow
.
Two days ago, the family took her to the hospital for examination, although the blood sugar was not high, but blood pressure, blood sodium were significantly lower than normal, the three major axes (pituitary-adrenal axis, pituitary-thyroid axis, pituitary-gonadal axis) hormone levels were generally reduced, and cranial MRI (MRI) found that the pituitary gland had an infarction focus, and the final diagnosis was "Houssay syndrome"
.
Glucocorticoids (hydrocortisone) and thyroid hormone replacement therapy were given to treatment, and after 2~3 weeks, Mr.
Zhang's symptoms such as chills, poor appetite, and drowsiness were significantly improved, and his face was not swollen.
But at the same time, her blood sugar gradually began to rise again, so she resumed insulin therapy, and now her blood sugar is well controlled and everything is back as before
.
What exactly is "Housay syndrome"? Why does this disease cause the blood sugar of diabetics to return to normal on its own? All this has to start
with the function of the pituitary gland.
We know that the pituitary gland (including adenopituitary and neuropituitary) is an important central endocrine organ of the human body, when the pituitary gland is diseased for some reasons, it secretes various secretion-stimulating hormones (such as adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropin, etc.
) and target glands regulated by secretagotropins Hormones (such as adrenal glands, thyroid gland, gonads, etc.
) (such as adrenal corticosteroids, thyroid hormones, sex hormones, etc.
) are reduced, and these hormones are insulin antagonists (i.
e.
, "glycemic hormones"), which have the effect of
raising blood sugar.
Therefore, when the secretion of these insulin-antagonistic hormones is reduced, it will lead to a decrease in the patient's blood sugar and the disappearance of "three more and one less" diabetes symptoms
.
Where to see more endocrinology clinical knowledge? Come to the "doctor's station" and take a look 👇
diabetes "remission", be wary!
Diabetes is a lifelong disease, and generally only a small number of mild type 2 diabetes patients can achieve "clinical remission" through early "intensive insulin therapy", that is, patients do not need to inject insulin or take hypoglycemic drugs, and rely solely on diet control and exercise therapy to maintain normal
blood sugar.
"Cure diabetes" is the common wish of all diabetics, but with the current level of science and technology and medical status can not be achieved for the time being, but in real life, sometimes there is really this kind of pie in the sky "good things", let's take a look at the following example:
Clinical examples
Teacher Zhang diagnosed diabetes shortly after retiring from school, and for more than a decade since then, she has lived like an ascetic, strictly controlling her diet, exercising rain or shine, and injecting insulintwice a day.
Although Mr.
Zhang has controlled his blood sugar well over the years, he knows
it bitterly.
Teacher Zhang often pours bitter water on his neighbors: "How good it would be if we could cure diabetes, stop taking injections and medicines every day, eat whatever you want, and don't have to worry about blood sugar rising!" "
Unexpectedly, Teacher Zhang's wish really came true not long ago!
After the Spring Festival this year, she often felt flustered, sweating, hunger, and her blood sugar was low for many times.
The diabetes that has plagued Teacher Zhang for many years is finally "good", it stands to reason that Teacher Zhang should be happy, but on the contrary, Teacher Zhang, who has always been crisp and neat, quick to talk, is like a changed person, listless all day, silent, not thinking about eating, fatigue and lethargy, and the personality is particularly afraid of cold, Yangchun March is still wearing thick cotton clothes at home, and his face looks a little swollen and sallow
.
Two days ago, the family took her to the hospital for examination, although the blood sugar was not high, but blood pressure, blood sodium were significantly lower than normal, the three major axes (pituitary-adrenal axis, pituitary-thyroid axis, pituitary-gonadal axis) hormone levels were generally reduced, and cranial MRI (MRI) found that the pituitary gland had an infarction focus, and the final diagnosis was "Houssay syndrome"
.
Glucocorticoids (hydrocortisone) and thyroid hormone replacement therapy were given to treatment, and after 2~3 weeks, Mr.
Zhang's symptoms such as chills, poor appetite, and drowsiness were significantly improved, and his face was not swollen.
But at the same time, her blood sugar gradually began to rise again, so she resumed insulin therapy, and now her blood sugar is well controlled and everything is back as before
.
What exactly is this "weird" Housay syndrome?
What exactly is "Housay syndrome"? Why does this disease cause the blood sugar of diabetics to return to normal on its own? All this has to start
with the function of the pituitary gland.
We know that the pituitary gland (including adenopituitary and neuropituitary) is an important central endocrine organ of the human body, when the pituitary gland is diseased for some reasons, it secretes various secretion-stimulating hormones (such as adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropin, etc.
) and target glands regulated by secretagotropins Hormones (such as adrenal glands, thyroid gland, gonads, etc.
) (such as adrenal corticosteroids, thyroid hormones, sex hormones, etc.
) are reduced, and these hormones are insulin antagonists (i.
e.
, "glycemic hormones"), which have the effect of
raising blood sugar.
Therefore, when the secretion of these insulin-antagonistic hormones is reduced, it will lead to a decrease in the patient's blood sugar and the disappearance of "three more and one less" diabetes symptoms
.
"Houssay syndrome", also known as "diabetes self-remission syndrome", refers to a metabolic syndrome
caused by diabetes mellitus combined with anterior pituitary hypofunction.
The reason why Mr.
Zhang's diabetes is not cured in the article is because diabetic microangiopathy causes pituitary infarction, resulting in hypopituitary function and insufficient secretion of glycemic hormone (such as adrenal corticosteroid, thyroid hormone, growth hormone, etc.
), but this normal blood sugar is not a good thing, but the result
of one disease masking another disease.
"Houssay syndrome" is not difficult to diagnose, through detailed history (diabetes mellitus resolves spontaneously or even hypoglycemia) + physical examination (apathy, thinning hair, dry skin, etc.
) + laboratory tests [electrolyte abnormalities (eg, low sodium), pituitary and target gland (adrenal, thyroid, gonadal) hormone levels decreased] + MRI of the pituitary gland can confirm the diagnosis
.
Therefore, diabetes "self-healing" is not necessarily a good thing, it is likely to be "pituitary stroke" or "pituitary inflammation"
.
Once this situation is encountered clinically, it must be paid attention to, so as not to let patients mistakenly take bad things for good things and delay the diagnosis and treatment
of the primary disease.
And it is also necessary to inform diabetic patients that diabetes "remission" ≠ "cure", and if patients relax self-management, high blood sugar will still return!
References:
[1] Wang Jianhua.
Diabetes self-management lecture hall[M].
Beijing:China Science and Technology Press,2017:58-59.
)
Where to see more endocrinology clinical knowledge? Come to the "doctor's station" and take a look 👇
