View More View Less
  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
  • 2 Magyar Tudományos Akadémia Molekuláris Medicina Kutatócsoport Budapest
Open access

A nem alkoholos zsírmáj a leggyakoribb májbetegség metabolikus szindrómában. Kialakulása összetett, többtényezős, döntően az inzulinrezisztencián alapuló folyamat, amelyben az endokrin rendszer eltérései is jelentősek. Több endokrinológiai megbetegedés okozhat zsírmájat, így például a hypothyreosis, hyperlipidaemia és elhízás révén vezethet nem alkoholos steatohepatitis kialakulásához. A felnőttkori növekedésihormon-hiány szintén elhízást, a metabolikus szindrómához hasonló anyagcsere-rendellenességet okoz. A hypercortisolismus is a metabolikus szindrómára jellemző jegyekkel társul. Addison-kóros betegekben is gyakran kisfokban nő a májenzimek aktivitása. A nem alkoholos zsírmáj kétszer gyakoribb postmenopausában, mint praemenopausában, a női nemi hormonpótló kezelés csökkenti ugyanakkor a májelzsírosodás kockázatát. Az inzulinrezisztencia, a 2-es típusú cukorbetegség, az alvási apnoe, a szív-ér rendszeri betegségek és a nem alkoholos zsírmáj is gyakoribb polycystás ovarium szindrómában. Férfiakban a csökkent androgénszint, nőkben a hyperandrogenismus elhízás és inzulinrezisztencia révén vezethet nem alkoholos zsírmáj kialakulásához. A zsírsejtek által termelt hormonok (leptin, aciláció stimulálta fehérje és adiponektin) is szerepet játszhatnak a nem alkoholos zsírmáj kialakulásában. A cryptogen májbetegségek hátterében az endokrin rendszer eltéréseire is gondolnunk kell. A nem alkoholos zsírmáj és az endokrin rendszer összefüggésének megismerése bővítheti a jövőben a kezelés lehetőségeit.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Kim, C. H., Younossi, Z. M.: Nonalcoholic fatty liver disease: a manifestation of the metabolic syndrome. Cleve Clin. J. Med., 2008, 75 , 721–728.

    Younossi Z. M. , 'Nonalcoholic fatty liver disease: a manifestation of the metabolic syndrome ' (2008 ) 75 Cleve Clin. J. Med. : 721 -728.

    • Search Google Scholar
  • Neuschwander-Tetri, B. A.: Nonalcoholic steatohepatitis and the metabolic syndrome. Am. J. Med. Sci., 2005, 330 , 326–335.

    Neuschwander-Tetri B. A. , 'Nonalcoholic steatohepatitis and the metabolic syndrome ' (2005 ) 330 Am. J. Med. Sci. : 326 -335.

    • Search Google Scholar
  • Fehér J., Németh E., Lengyel G.: A nem alkoholos steatohepatitis (NASH) a metabolikus szindróma része? Orv. Hetil., 2004, 145 , 1499–1506.

    Lengyel G. , 'A nem alkoholos steatohepatitis (NASH) a metabolikus szindróma része? ' (2004 ) 145 Orv. Hetil. : 1499 -1506.

    • Search Google Scholar
  • Ábel T., Fehér J.: A nem alkoholos zsírmáj és a szív-ér rendszeri kockázat. Orv. Hetil., 2008, 149 , 1299–1305.

    Fehér J. , 'A nem alkoholos zsírmáj és a szív-ér rendszeri kockázat ' (2008 ) 149 Orv. Hetil. : 1299 -1305.

    • Search Google Scholar
  • Harper, M. E., Seifert, E.: Thyroid hormone effects on mitochondrial energetics. Thyroid, 2008, 18 , 145–156.

    Seifert E. , 'Thyroid hormone effects on mitochondrial energetics ' (2008 ) 18 Thyroid : 145 -156.

    • Search Google Scholar
  • Berkenstam, A., Farnegardh, M., Gustafsson, J-A.: Convergence of lipid homeostasis through liver X and thyroid hormone receptor. Mechanism Aging Dev., 2004, 125 , 707–717.

    Gustafsson J-A. , 'Convergence of lipid homeostasis through liver X and thyroid hormone receptor ' (2004 ) 125 Mechanism Aging Dev. : 707 -717.

    • Search Google Scholar
  • Malik, R., Hodgson, H.: The relationship between the thyroid gland and the liver. QJM, 2002, 95 , 559–569.

    Hodgson H. , 'The relationship between the thyroid gland and the liver ' (2002 ) 95 QJM : 559 -569.

    • Search Google Scholar
  • Duntas, L. H.: Thyroid disease and lipids. Thyroid, 2002, 12 , 287–293.

    Duntas L. H. , 'Thyroid disease and lipids ' (2002 ) 12 Thyroid : 287 -293.

  • Daher, R., Yazbeck, T., Jaoude, J. B. és mtsa: Consequences of dysthyroidism on the digestive tract and Viscera. W. J. Gastroenterol., 2009, 15 , 2834–2838.

    Jaoude J. B. , 'Consequences of dysthyroidism on the digestive tract and Viscera ' (2009 ) 15 W. J. Gastroenterol. : 2834 -2838.

    • Search Google Scholar
  • Lonardo, A., Carani, C., Carulli, N. és mtsa: ‘Endocrine NAFLD’ a hormonocentric perspective of nonalcoholic fatty liver pathogenesis. J. Hepatol., 2006, 44 , 1196–1207.

    Carulli N. , '‘Endocrine NAFLD’ a hormonocentric perspective of nonalcoholic fatty liver pathogenesis ' (2006 ) 44 J. Hepatol. : 1196 -1207.

    • Search Google Scholar
  • Loria, P., Carulli, L., Bertolotti, M. és mtsa: Endocrine and liver interaction: the role of endocrine pathways in NASH. Nat. Rev. Gastroenterol. Hepatol., 2009, 6 , 236–247.

    Bertolotti M. , 'Endocrine and liver interaction: the role of endocrine pathways in NASH ' (2009 ) 6 Nat. Rev. Gastroenterol. Hepatol. : 236 -247.

    • Search Google Scholar
  • Jeong-Seon, J., Hiun-Suk, C., Young-Seok, C. és mtsai: Myxedema ascites: Case report and literature review. J. Korean. Med. Sci., 2006, 21 , 761–764.

    Young-Seok C. , 'Myxedema ascites: Case report and literature review ' (2006 ) 21 J. Korean. Med. Sci. : 761 -764.

    • Search Google Scholar
  • Lichanska, A. M., Waters, M. J.: New insights into growth hormone receptor function and clinical implications. Hormon Res., 2008, 69 , 138–145.

    Waters M. J. , 'New insights into growth hormone receptor function and clinical implications ' (2008 ) 69 Hormon Res. : 138 -145.

    • Search Google Scholar
  • Waters, M. J., Hoang, H. N., Fairlie, D. P. és mtsai: New insights into growth hormone acton. J. Mol. Endocrinol., 2006, 36 , 1–7.

    Fairlie D. P. , 'New insights into growth hormone acton ' (2006 ) 36 J. Mol. Endocrinol. : 1 -7.

    • Search Google Scholar
  • Pennisi, P. A., Kopchick, J. J., Thorgeirsson, S. és mtsai: Role of growth hormone (GH) in liver regeneration. Endocrinology, 2004, 145 , 4748–4755.

    Thorgeirsson S. , 'Role of growth hormone (GH) in liver regeneration ' (2004 ) 145 Endocrinology : 4748 -4755.

    • Search Google Scholar
  • Ichikawa, T., Hamasaki, K., Ishikawa, H. és mtsai: Non-alcoholic steatohepatitis and hepatic steatosis in patients with adult onset growth hormone deficiency. Gut, 2003, 52 , 914.

    Ishikawa H. , 'Non-alcoholic steatohepatitis and hepatic steatosis in patients with adult onset growth hormone deficiency ' (2003 ) 52 Gut : 914 -.

    • Search Google Scholar
  • Takahashi, Y., Iida, K., Takahashi, K. és mtsai: Growth hormone reverses nonalcoholic steatohepatitis in a patient with adult growth hormone deficiency. Gastroenterology, 2007, 132 , 938–943.

    Takahashi K. , 'Growth hormone reverses nonalcoholic steatohepatitis in a patient with adult growth hormone deficiency ' (2007 ) 132 Gastroenterology : 938 -943.

    • Search Google Scholar
  • Itoh, E., Hizuka, N., Fukuda, I. és mtsa: Metabolic disorders in adult growth hormone deficiency: A study of 110 patients at a single institute in Japan. Endocr. J., 2006, 53 , 539–545.

    Fukuda I. , 'Metabolic disorders in adult growth hormone deficiency: A study of 110 patients at a single institute in Japan ' (2006 ) 53 Endocr. J. : 539 -545.

    • Search Google Scholar
  • Salerno, M., Di Maio, S., Ferri, P. és mtsai: Liver abnormalities during growth hormone treatment. J. Pediatr. Gastroenterol. Nutr., 2000, 31 , 149–151.

    Ferri P. , 'Liver abnormalities during growth hormone treatment ' (2000 ) 31 J. Pediatr. Gastroenterol. Nutr. : 149 -151.

    • Search Google Scholar
  • Dallman, M. F., Warne, J. P., Foster, M. T. és mtsa: Glucocorticoids and insulin both modulate caloric intake through actions on the brain. J. Physiol., 2007, 583 , 431–436.

    Foster M. T. , 'Glucocorticoids and insulin both modulate caloric intake through actions on the brain ' (2007 ) 583 J. Physiol. : 431 -436.

    • Search Google Scholar
  • Qi, D., Rodrigues, B.: Glucocorticoids produce whole body insulin resistance with changes in cardiac metabolism. Am. J. Physiol. Endocrinol. Metab., 2007, 292 , E654–667.

    Rodrigues B. , 'Glucocorticoids produce whole body insulin resistance with changes in cardiac metabolism ' (2007 ) 292 Am. J. Physiol. Endocrinol. Metab. : E654 -667.

    • Search Google Scholar
  • Morton, N. M., Seckl, J. R.: 11-beta-hydroxysteroid dehydrogenase type 1 and obesity. Front. Horm. Res., 2008, 36 , 146–164.

    Seckl J. R. , '11-beta-hydroxysteroid dehydrogenase type 1 and obesity ' (2008 ) 36 Front. Horm. Res. : 146 -164.

    • Search Google Scholar
  • Gross, K. L., Cidlowski, J. A.: Tissue-specific glucocorticoid action: a family affair. Trends Endocrinol. Metab., 2008, 19 , 331–339.

    Cidlowski J. A. , 'Tissue-specific glucocorticoid action: a family affair ' (2008 ) 19 Trends Endocrinol. Metab. : 331 -339.

    • Search Google Scholar
  • Stimson, R. H., Walker, B. R.: Glucocorticoids and 11beta-hydroxysteroid dehydrogenase type 1 in obesity and the metabolic syndrome. Minerva Endocrinol., 2007, 32 , 141–159.

    Walker B. R. , 'Glucocorticoids and 11beta-hydroxysteroid dehydrogenase type 1 in obesity and the metabolic syndrome ' (2007 ) 32 Minerva Endocrinol. : 141 -159.

    • Search Google Scholar
  • Gurakuqi, G. C., Stadlbauer, V., Stepan, V. és mtsai: Addison’s disease as a rare cause of chronically elevated liver enzymes. Z. Gastroenterol., 2006, 44 , 179–183.

    Stepan V. , 'Addison’s disease as a rare cause of chronically elevated liver enzymes ' (2006 ) 44 Z. Gastroenterol. : 179 -183.

    • Search Google Scholar
  • Rizvi, A. A., Kerrick, J. G.: Liver involvement and abnormal iron variables in undiagnosed Addison’s disease. Endocr. Pract., 2001, 7 , 184–188.

    Kerrick J. G. , 'Liver involvement and abnormal iron variables in undiagnosed Addison’s disease ' (2001 ) 7 Endocr. Pract. : 184 -188.

    • Search Google Scholar
  • Ersan, Ö., Demirezer, B.: Addison’s disease: a rare cause of hypertransaminasaemia. Dig. Dis. Sci., 2008, 53 , 3269–3271.

    Demirezer B. , 'Addison’s disease: a rare cause of hypertransaminasaemia ' (2008 ) 53 Dig. Dis. Sci. : 3269 -3271.

    • Search Google Scholar
  • Szafran, H., Smielak-Korombel, W.: The role of estrogens in hormonal regulation of lipid metabolism in women. Przegl. Lek., 1998, 55 , 266–270.

    Smielak-Korombel W. , 'The role of estrogens in hormonal regulation of lipid metabolism in women ' (1998 ) 55 Przegl. Lek. : 266 -270.

    • Search Google Scholar
  • Shimizu, I., Kohno, N., Tamaki, K. és mtsai: Female hepatology: favorable role of estrogen in chronic liver disease with hepatitis B virus infection. W. J. Gastroenterol., 2007, 13 , 4295–4305.

    Tamaki K. , 'Female hepatology: favorable role of estrogen in chronic liver disease with hepatitis B virus infection ' (2007 ) 13 W. J. Gastroenterol. : 4295 -4305.

    • Search Google Scholar
  • Mattsson, C., Olsson, T.: Estrogens and glucocorticoid hormones in adipose tissue metabolism. 2007, 14, 2918–2924.

  • Louet, J. F., LeMay, C., Mauvais-Jarvis, F.: Antidiabetic actions of estrogen: insight from human and genetic mouse models. Curr. Atheroscler. Rep., 2004, 6 , 180–185.

    Mauvais-Jarvis F. , 'Antidiabetic actions of estrogen: insight from human and genetic mouse models ' (2004 ) 6 Curr. Atheroscler. Rep. : 180 -185.

    • Search Google Scholar
  • Kapoor, D., Jones, T. H.: Androgen deficiency as a predictor of metabolic syndrome in aging men: an opportunity for intervention? Drugs Aging, 2008, 25 , 357–369.

    Jones T. H. , 'Androgen deficiency as a predictor of metabolic syndrome in aging men: an opportunity for intervention? ' (2008 ) 25 Drugs Aging : 357 -369.

    • Search Google Scholar
  • Allan, C. A., Strauss, B. J., Burger, H. G. és mtsai: Testosterone therapy prevents gain in visceral adipose tissue and loss of skeletal muscle in nonobese aging men. J. Clin. Endocrinol. Metab., 2008, 93 , 139–146.

    Burger H. G. , 'Testosterone therapy prevents gain in visceral adipose tissue and loss of skeletal muscle in nonobese aging men ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 139 -146.

    • Search Google Scholar
  • Allan, C. A., Strauss, B. J., McLachlan, R. I.: Body composition, metabolic syndrome and testosterone in ageing men. Int. J. Impot. Res., 2007, 19 , 448–457.

    McLachlan R. I. , 'Body composition, metabolic syndrome and testosterone in ageing men ' (2007 ) 19 Int. J. Impot. Res. : 448 -457.

    • Search Google Scholar
  • Setji, T. L., Brown, A. J.: Polycystic ovary syndrome: diagnosis and treatment. Am. J. Med., 2007, 120 , 128–132.

    Brown A. J. , 'Polycystic ovary syndrome: diagnosis and treatment ' (2007 ) 120 Am. J. Med. : 128 -132.

    • Search Google Scholar
  • Carmina, E.: Need for liver evaluation in polycystic ovary syndrome. J. Hepatol., 2007, 47 , 313–315.

    Carmina E. , 'Need for liver evaluation in polycystic ovary syndrome ' (2007 ) 47 J. Hepatol. : 313 -315.

    • Search Google Scholar
  • Cerda, C., Perez-Ayuso, R. M., Riquelme, A. és mtsai: Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. J. Hepatol., 2007, 47 , 313–315.

    Riquelme A. , 'Nonalcoholic fatty liver disease in women with polycystic ovary syndrome ' (2007 ) 47 J. Hepatol. : 313 -315.

    • Search Google Scholar
  • Brzozowska, M. M., Ostapowitz, G., Weltman, M. D.: An association between nonalcoholic fatty liver disease and polycystic ovarian syndrome. J. Gastroenterol. Hepatol., 2009, 24 , 243–247.

    Weltman M. D. , 'An association between nonalcoholic fatty liver disease and polycystic ovarian syndrome ' (2009 ) 24 J. Gastroenterol. Hepatol. : 243 -247.

    • Search Google Scholar
  • Schenk, S., Saberi, M., Olefsky, J. M.: Insulin sensitivity: modulation by nutrients and inflammation. J. Clin. Invest., 2008, 118 , 2992–3002.

    Olefsky J. M. , 'Insulin sensitivity: modulation by nutrients and inflammation ' (2008 ) 118 J. Clin. Invest. : 2992 -3002.

    • Search Google Scholar
  • Ahrén, B.: GLP-1 and extra-islet effects. Horm. Metab. Res., 2004, 36 , 842–845.

    Ahrén B. , 'GLP-1 and extra-islet effects ' (2004 ) 36 Horm. Metab. Res. : 842 -845.

  • Moran, T. H., Dailey, M. J.: Minireview: Gut peptides: targets for antiobesity drug development? Endocrinology, 2009, 150 , 2526–2530.

    Dailey M. J. , 'Minireview: Gut peptides: targets for antiobesity drug development? ' (2009 ) 150 Endocrinology : 2526 -2530.

    • Search Google Scholar
  • Potenza, M., Rayfield, E. J.: Targeting the incretin system in type 2 diabetes mellitus. Mt. Sinai J. Med., 2009, 76 , 244–256.

    Rayfield E. J. , 'Targeting the incretin system in type 2 diabetes mellitus ' (2009 ) 76 Mt. Sinai J. Med. : 244 -256.

    • Search Google Scholar
  • Rabe, K., Lehrke, M., Parhofer, K. G. és mtsa: Adipokines and insulin resistance. Mol. Med., 2008, 14 , 741–751.

    Parhofer K. G. , 'Adipokines and insulin resistance ' (2008 ) 14 Mol. Med. : 741 -751.

  • Guzik, T. J., Mangalat, D., Korbut, R.: Adipocytokines. Novel link between inflammation and vascular function? J. Physiol. Pharmacol., 2006, 57 , 505–528.

    Korbut R. , 'Adipocytokines. Novel link between inflammation and vascular function? ' (2006 ) 57 J. Physiol. Pharmacol. : 505 -528.

    • Search Google Scholar
  • Polyzos, S. A., Kountouras, J., Zavos, C.: Nonalcoholic fatty liver disease: the pathogenetic roles of insulin resistance and adipocytokines. Curr. Mol. Med., 2009, 9 , 299–314.

    Zavos C. , 'Nonalcoholic fatty liver disease: the pathogenetic roles of insulin resistance and adipocytokines ' (2009 ) 9 Curr. Mol. Med. : 299 -314.

    • Search Google Scholar
  • Havel, P. J.: Update on adipocyte hormones: regulation of energy balance and carbohydrate/lipid metabolism. Diabetes, 2004, 53 , S143–S151.

    Havel P. J. , 'Update on adipocyte hormones: regulation of energy balance and carbohydrate/lipid metabolism ' (2004 ) 53 Diabetes : S143 -S151.

    • Search Google Scholar
  • Dyck, D. J.: Adipokines as regulators of muscle metabolism and insulin sensitivity. Appl. Physiol. Nutr. Metab., 2009, 34 , 396–402.

    Dyck D. J. , 'Adipokines as regulators of muscle metabolism and insulin sensitivity ' (2009 ) 34 Appl. Physiol. Nutr. Metab. : 396 -402.

    • Search Google Scholar
  • Maia-Fernandes, T., Roncon-Albuquerque, R. Jr., Leite-Moreira, A. F.: Cardiovascular actions of adiponectin: pathophysiologic implications. Rev. Port. Cardiol., 2008, 27 , 1431–1449.

    Maia-Fernandes T., Roncon-Albuquerque, R. Jr., Leite-Moreira, A. F. , 'Cardiovascular actions of adiponectin: pathophysiologic implications ' (2008 ) 27 Rev. Port. Cardiol. : 1431 -1449.

    • Search Google Scholar
  • Whitehead, J. P., Richards, A. A., Hickmanm I. J. és mtsai: Adiponectin – a key adipokine in the metabolic syndrome. Diabetes Obes. Metab., 2006, 8 , 264–280.

    Hickmanm I. J. , 'Adiponectin – a key adipokine in the metabolic syndrome ' (2006 ) 8 Diabetes Obes. Metab. : 264 -280.

    • Search Google Scholar
  • Prins, J. B.: Adipose tissue as an endocrine organ. Best. Pract. Res. Clin. Endocrinol. Metabol., 2002, 16 , 639–651.

    Prins J. B. , 'Adipose tissue as an endocrine organ ' (2002 ) 16 Best. Pract. Res. Clin. Endocrinol. Metabol. : 639 -651.

    • Search Google Scholar