Die HPA-Achse als mögliches Bindeglied zwischen Depression, Diabetes mellitus und kognitiven Störungen

Zusammenfassung

Beim Diabetes mellitus und bei der Depression ist eine Überaktivität der Hypothalamus-Hypophysen-Nebennierenrinden-Achse (HPA-Achse) mit konsekutiver Hyperkortisolämie beschrieben. Eine Hyperkortisolämie ist mit einer Beeinträchtigung kognitiver Funktionen assoziiert. Weiterhin ist bekannt, dass diese neuroendokrinologische Störung zu einer Insulinresistenz führen und eine gute Blutzuckereinstellung bei Diabetikern deutlich erschweren kann. Ein Zusammenhang zwischen kognitiven und depressiven Störungen beim Diabetes mellitus mit einer Überfunktion der HPA-Achse ist wahrscheinlich. Eine Normalisierung der HPA-Achse könnte zu einer Besserung beider Störungsaspekte führen. Eine Mitbehandlung der Depression könnte via HPA-Achsen-Normalisierung eine erleichterte Blutzuckereinstellung und verbesserte kognitive Leistungen nach sich ziehen. Die Überprüfung dieser Zusammenhänge durch Studien ist notwendig und von klinischer Bedeutung.

Abstract

Patients suffering from diabetes mellitus and depressive patients show a hyperactivity of the hypothalamic-pituitary-adrenocortical axis (HPA-axis) with hypercortisolemia. Hypercortisolemia is associated with cognitive dysfunction. These neuroendocrinological disturbances can cause an insulin resistance syndrome which complicates the regulation of blood glucose. Cognitive and depressive disorders in patients with diabetes mellitus might be associated with a hyperactivity of the HPA-axis. By normalising the HPA-axis both disorders could be improved. In addition, one can expect that antidepressive treatment with normalization of the HPA-axis could improve the metabolic situation and cognitive dysfunction. There is need for further research to study the associations between depression, diabetes mellitus and cognitive dysfunction.

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