臨牀消化器内科 Vol.28 No.4(6-5)


特集名 NASH ― 病態と治療
題名 NASHの成因と病態 (5) 二次性NASHの病態
発刊年月 2013年 04月
著者 徳重 克年 東京女子医科大学消化器内科
【 要旨 】 NASHは肥満や生活習慣病を基盤として発症する症例がほとんどである.しかし,下垂体機能低下症,薬剤(タモキシフェンなど),甲状腺機能低下症,多囊胞卵巣症候群,閉塞性睡眠時無呼吸症候群,性腺機能低下症,膵頭十二指腸切除,短腸症候群もNASHの重要な危険因子,いわゆる二次性NASHの原因と考えられている.とくに,視床下部障害も伴った下垂体機能低下症では,若年で進行も速いことから注意が必要である.さらに下垂体機能低下NASHには成長ホルモン(GH)投与が有効とされる.二次性NASHの病態の解明は,本来のNASHの治療に繫がる可能性もあり今後注目される.
Theme NASH -- Pathogenesis and Treatment
Title Secondary NASH
Author Katsutoshi Tokushige Department of Internal Medicine and Gastroenterology, Tokyo Womenʼs Medical University
[ Summary ] Most cases of NASH develop due to obesity and lifestyle-related diseases. However, hypopituitarism, medications (such as tamoxifen), hypothyroidism, polycystic ovary syndrome, obstructive sleep apnea, hypogonadism, pancreaticoduodenectomies, and short bowel syndrome are also thought to be important risk factors for NASH or secondary NASH. We need to pay particular attention to young NASH patients with hypopituitarism and hypothalamic disorders, since their conditions can progress rapidly. For those young NASH patients with hypopituitarism, it has been reported that GH treatment is effective. These findings suggest that elucidation of the pathogenesis of secondary NASH may lead to a therapy for primary NASH.
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