DIABETES MELLITUS – Secondary Diabetes



Diabetes that is secondary to an identifiable condition is comparatively rare. For example, de­struction of the pancreas secondary to pancreatitis will impair insulin secretion and result in dia­betes. In certain endocrine disorders such as Cushing’s syndrome, acromegaly, pheochromo-cytoma, and glucagonoma, the increased secre­tion of hormones that counteract the effect of in­sulin can also result in hyperglycemia. By a variety of mechanisms, a number of commonly used drugs such as diuretics, corticosteroids, pro­pranolol, phenytoin, and adrenergic agents also cause or exacerbate diabetes.
Acanthosis nigricans may be associated with se­vere insulin resistance, resulting in diabetes by two distinct mechanisms: (1) Type A—the insulin resistance is due to a marked decrease in the num­ber of cellular insulin receptors. These patients are usually young females with hirsutism and po­lycystic ovaries. (2) Type B—the insulin resist­ance is due to autoantibodies against the insulin receptor as part of a more generalized autoim­mune process manifested by proteinuria, leuko­penia, and antinuclear antibodies.




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