Skip to main content
Erschienen in: Endocrine 2/2018

23.03.2018 | Mini Review

Klinefelter syndrome, insulin resistance, metabolic syndrome, and diabetes: review of literature and clinical perspectives

verfasst von: Andrea Salzano, Roberta D’Assante, Liam M. Heaney, Federica Monaco, Giuseppe Rengo, Pietro Valente, Daniela Pasquali, Eduardo Bossone, Daniele Gianfrilli, Andrea Lenzi, Antonio Cittadini, Alberto M. Marra, Raffaele Napoli

Erschienen in: Endocrine | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Klinefelter syndrome (KS), the most frequent chromosomic abnormality in males, is associated with hypergonadotropic hypogonadism and an increased risk of cardiovascular diseases (CVD). The mechanisms involved in increasing risk of cardiovascular morbidity and mortality are not completely understood. This review summarises the current understandings of the complex relationship between KS, metabolic syndrome and cardiovascular risk in order to plan future studies and improve current strategies to reduce mortality in this high-risk population.

Methods

We searched PubMed, Web of Science, and Scopus for manuscripts published prior to November 2017 using key words "Klinefelter syndrome" AND "insulin resistance" OR "metabolic syndrome" OR "diabetes mellitus" OR "cardiovascular disease" OR "testosterone". Manuscripts were collated, studied and carried forward for discussion where appropriate.

Results

Insulin resistance, metabolic syndrome, and type 2 diabetes are more frequently diagnosed in KS than in the general population; however, the contribution of hypogonadism to metabolic derangement is highly controversial. Whether this dangerous combination of risk factors fully explains the CVD burden of KS patients remains unclear. In addition, testosterone replacement therapy only exerts a marginal action on the CVD system.

Conclusion

Since fat accumulation and distribution seem to play a relevant role in triggering metabolic abnormalities, an early diagnosis and a tailored intervention strategy with drugs aimed at targeting excessive visceral fat deposition appear necessary in patients with KS.
Literatur
1.
Zurück zum Zitat H.F. Klinefelter, E.C. Reifenstein, F. Albright, Syndrome characterized by gynaecomastia, aspermatogenesis without a-Leydigism, and increased excretion of follicle stimulating hormone. J. Clin. Endocrinol. 2(11), 615–627 (1942)CrossRef H.F. Klinefelter, E.C. Reifenstein, F. Albright, Syndrome characterized by gynaecomastia, aspermatogenesis without a-Leydigism, and increased excretion of follicle stimulating hormone. J. Clin. Endocrinol. 2(11), 615–627 (1942)CrossRef
12.
Zurück zum Zitat D. Liberato, S. Granato, D. Grimaldi, F.M. Rossi, N. Tahani, D. Gianfrilli, A. Anzuini, A. Lenzi, G. Cavaggioni, A.F. Radicioni, Fluid intelligence, traits of personality and personality disorders in a cohort of adult KS patients with the classic 47, XXY karyotype. J. Endocrinol. Invest. 40(11), 1191–1199 (2017). https://doi.org/10.1007/s40618-017-0674-2 CrossRefPubMed D. Liberato, S. Granato, D. Grimaldi, F.M. Rossi, N. Tahani, D. Gianfrilli, A. Anzuini, A. Lenzi, G. Cavaggioni, A.F. Radicioni, Fluid intelligence, traits of personality and personality disorders in a cohort of adult KS patients with the classic 47, XXY karyotype. J. Endocrinol. Invest. 40(11), 1191–1199 (2017). https://​doi.​org/​10.​1007/​s40618-017-0674-2 CrossRefPubMed
17.
Zurück zum Zitat W.H. Price, J.F. Clayton, S. Collyer, R. de Mey, Mortality ratios and life expectancy in X chromatin positive males. J. Epidemiol. Community Health 39(1), 33–38 (1985)CrossRefPubMedPubMedCentral W.H. Price, J.F. Clayton, S. Collyer, R. de Mey, Mortality ratios and life expectancy in X chromatin positive males. J. Epidemiol. Community Health 39(1), 33–38 (1985)CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat A. Salzano, M. Arcopinto, A.M. Marra, E. Bobbio, D. Esposito, G. Accardo, F. Giallauria, E. Bossone, C. Vigorito, A. Lenzi, D. Pasquali, A.M. Isidori, A. Cittadini, Klinefelter syndrome, cardiovascular system, and thromboembolic disease: review of literature and clinical perspectives. Eur. J. Endocrinol. 175(1), R27–R40 (2016). https://doi.org/10.1530/EJE-15-1025 PubMedCrossRef A. Salzano, M. Arcopinto, A.M. Marra, E. Bobbio, D. Esposito, G. Accardo, F. Giallauria, E. Bossone, C. Vigorito, A. Lenzi, D. Pasquali, A.M. Isidori, A. Cittadini, Klinefelter syndrome, cardiovascular system, and thromboembolic disease: review of literature and clinical perspectives. Eur. J. Endocrinol. 175(1), R27–R40 (2016). https://​doi.​org/​10.​1530/​EJE-15-1025 PubMedCrossRef
20.
Zurück zum Zitat National Cholesterol Education Program Expert Panel on Detection, E., Treatment of High Blood Cholesterol in, A., Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106(25), 3143–3421 (2002)CrossRef National Cholesterol Education Program Expert Panel on Detection, E., Treatment of High Blood Cholesterol in, A., Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106(25), 3143–3421 (2002)CrossRef
21.
Zurück zum Zitat E.S. Ford, Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 28(11), 2745–2749 (2005)CrossRefPubMed E.S. Ford, Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 28(11), 2745–2749 (2005)CrossRefPubMed
22.
Zurück zum Zitat K.G. Alberti, R.H. Eckel, S.M. Grundy, P.Z. Zimmet, J.I. Cleeman, K.A. Donato, J.C. Fruchart, W.P. James, C.M. Loria, S.C. Smith Jr.; International Diabetes Federation Task Force on, E., Prevention, L. Hational Heart, I. Blood; American Heart, A., World Heart, F., International Atherosclerosis, S., International Association for the Study of, O., Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120(16), 1640–1645 (2009). https://doi.org/10.1161/CIRCULATIONAHA.109.192644 CrossRefPubMed K.G. Alberti, R.H. Eckel, S.M. Grundy, P.Z. Zimmet, J.I. Cleeman, K.A. Donato, J.C. Fruchart, W.P. James, C.M. Loria, S.C. Smith Jr.; International Diabetes Federation Task Force on, E., Prevention, L. Hational Heart, I. Blood; American Heart, A., World Heart, F., International Atherosclerosis, S., International Association for the Study of, O., Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120(16), 1640–1645 (2009). https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​109.​192644 CrossRefPubMed
24.
Zurück zum Zitat A. Bojesen, K. Kristensen, N.H. Birkebaek, J. Fedder, L. Mosekilde, P. Bennett, P. Laurberg, J. Frystyk, A. Flyvbjerg, J.S. Christiansen, C.H. Gravholt, The metabolic syndrome is frequent in Klinefelter’s syndrome and is associated with abdominal obesity and hypogonadism. Diabetes Care 29(7), 1591–1598 (2006). https://doi.org/10.2337/dc06-0145 CrossRefPubMed A. Bojesen, K. Kristensen, N.H. Birkebaek, J. Fedder, L. Mosekilde, P. Bennett, P. Laurberg, J. Frystyk, A. Flyvbjerg, J.S. Christiansen, C.H. Gravholt, The metabolic syndrome is frequent in Klinefelter’s syndrome and is associated with abdominal obesity and hypogonadism. Diabetes Care 29(7), 1591–1598 (2006). https://​doi.​org/​10.​2337/​dc06-0145 CrossRefPubMed
27.
Zurück zum Zitat D. Pei, W.H. Sheu, C.Y. Jeng, W.K. Liao, M.M. Fuh, Insulin resistance in patients with Klinefelter’s syndrome and idiopathic gonadotropin deficiency. J. Formos. Med. Assoc. 97(8), 534–540 (1998)PubMed D. Pei, W.H. Sheu, C.Y. Jeng, W.K. Liao, M.M. Fuh, Insulin resistance in patients with Klinefelter’s syndrome and idiopathic gonadotropin deficiency. J. Formos. Med. Assoc. 97(8), 534–540 (1998)PubMed
29.
31.
Zurück zum Zitat K. Mitsuhashi, T. Senmaru, T. Fukuda, M. Yamazaki, K. Shinomiya, M. Ueno, S. Kinoshita, J. Kitawaki, M. Katsuyama, M. Tsujikawa, H. Obayashi, N. Nakamura, M. Fukui, Testosterone stimulates glucose uptake and GLUT4 translocation through LKB1/AMPK signaling in 3T3-L1 adipocytes. Endocrine 51(1), 174–184 (2016). https://doi.org/10.1007/s12020-015-0666-y CrossRefPubMed K. Mitsuhashi, T. Senmaru, T. Fukuda, M. Yamazaki, K. Shinomiya, M. Ueno, S. Kinoshita, J. Kitawaki, M. Katsuyama, M. Tsujikawa, H. Obayashi, N. Nakamura, M. Fukui, Testosterone stimulates glucose uptake and GLUT4 translocation through LKB1/AMPK signaling in 3T3-L1 adipocytes. Endocrine 51(1), 174–184 (2016). https://​doi.​org/​10.​1007/​s12020-015-0666-y CrossRefPubMed
32.
Zurück zum Zitat E.M. Camacho, I.T. Huhtaniemi, T.W. O’Neill, J.D. Finn, S.R. Pye, D.M. Lee, A. Tajar, G. Bartfai, S. Boonen, F.F. Casanueva, G. Forti, A. Giwercman, T.S. Han, K. Kula, B. Keevil, M.E. Lean, N. Pendleton, M. Punab, D. Vanderschueren, F.C. Wu, E. Group, Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur. J. Endocrinol. 168(3), 445–455 (2013). https://doi.org/10.1530/EJE-12-0890 CrossRefPubMed E.M. Camacho, I.T. Huhtaniemi, T.W. O’Neill, J.D. Finn, S.R. Pye, D.M. Lee, A. Tajar, G. Bartfai, S. Boonen, F.F. Casanueva, G. Forti, A. Giwercman, T.S. Han, K. Kula, B. Keevil, M.E. Lean, N. Pendleton, M. Punab, D. Vanderschueren, F.C. Wu, E. Group, Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur. J. Endocrinol. 168(3), 445–455 (2013). https://​doi.​org/​10.​1530/​EJE-12-0890 CrossRefPubMed
34.
40.
Zurück zum Zitat S. Iwatsuki, S. Sasaki, K. Taguchi, T. Hamakawa, K. Mizuno, A. Okada, Y. Kubota, Y. Umemoto, Y. Hayashi, T. Yasui, Effect of obesity on sperm retrieval outcome and reproductive hormone levels in Japanese azoospermic men with and without Klinefelter syndrome. Andrology 5(1), 82–86 (2017). https://doi.org/10.1111/andr.12281 CrossRefPubMed S. Iwatsuki, S. Sasaki, K. Taguchi, T. Hamakawa, K. Mizuno, A. Okada, Y. Kubota, Y. Umemoto, Y. Hayashi, T. Yasui, Effect of obesity on sperm retrieval outcome and reproductive hormone levels in Japanese azoospermic men with and without Klinefelter syndrome. Andrology 5(1), 82–86 (2017). https://​doi.​org/​10.​1111/​andr.​12281 CrossRefPubMed
42.
Zurück zum Zitat V.A. Giagulli, M.D. Carbone, M.I. Ramunni, B. Licchelli, G. De Pergola, C. Sabba, E. Guastamacchia, V. Triggiani, Adding liraglutide to lifestyle changes, metformin and testosterone therapy boosts erectile function in diabetic obese men with overt hypogonadism. Andrology 3(6), 1094–1103 (2015). https://doi.org/10.1111/andr.12099 CrossRefPubMed V.A. Giagulli, M.D. Carbone, M.I. Ramunni, B. Licchelli, G. De Pergola, C. Sabba, E. Guastamacchia, V. Triggiani, Adding liraglutide to lifestyle changes, metformin and testosterone therapy boosts erectile function in diabetic obese men with overt hypogonadism. Andrology 3(6), 1094–1103 (2015). https://​doi.​org/​10.​1111/​andr.​12099 CrossRefPubMed
43.
Zurück zum Zitat S.J. Han, K.S. Kim, W. Kim, J.H. Kim, Y.H. Lee, J.S. Nam, J.A. Seo, B.K. Kim, J. Lee, J.O. Chung, M.H. Kim, T.S. Sohn, H.S. Choi, S.B. Hong, Y.S. Chung, Obesity and hyperglycemia in korean men with Klinefelter syndrome: the Korean Endocrine Society Registry. Endocrinol. Metab. 31(4), 598–603 (2016). https://doi.org/10.3803/EnM.2016.31.4.598 CrossRef S.J. Han, K.S. Kim, W. Kim, J.H. Kim, Y.H. Lee, J.S. Nam, J.A. Seo, B.K. Kim, J. Lee, J.O. Chung, M.H. Kim, T.S. Sohn, H.S. Choi, S.B. Hong, Y.S. Chung, Obesity and hyperglycemia in korean men with Klinefelter syndrome: the Korean Endocrine Society Registry. Endocrinol. Metab. 31(4), 598–603 (2016). https://​doi.​org/​10.​3803/​EnM.​2016.​31.​4.​598 CrossRef
47.
Zurück zum Zitat M. Rotondi, F. Coperchini, A. Renzullo, G. Accardo, D. Esposito, G. Groppelli, F. Magri, A. Cittadini, A.M. Isidori, L. Chiovato, D. Pasquali, High circulating levels of CCL2 in patients with Klinefelter’s syndrome. Clin. Endocrinol. 80(3), 465–467 (2014). https://doi.org/10.1111/cen.12245 CrossRef M. Rotondi, F. Coperchini, A. Renzullo, G. Accardo, D. Esposito, G. Groppelli, F. Magri, A. Cittadini, A.M. Isidori, L. Chiovato, D. Pasquali, High circulating levels of CCL2 in patients with Klinefelter’s syndrome. Clin. Endocrinol. 80(3), 465–467 (2014). https://​doi.​org/​10.​1111/​cen.​12245 CrossRef
48.
Zurück zum Zitat S. Belli, D. Santi, E. Leoni, E. Dall’Olio, F. Fanelli, M. Mezzullo, C. Pelusi, L. Roli, S. Tagliavini, T. Trenti, A.R. Granata, U. Pagotto, R. Pasquali, V. Rochira, C. Carani, M. Simoni, Human chorionic gonadotropin stimulation gives evidence of differences in testicular steroidogenesis in Klinefelter syndrome, as assessed by liquid chromatography-tandem mass spectrometry. Eur. J. Endocrinol. 174(6), 801–811 (2016). https://doi.org/10.1530/EJE-15-1224 CrossRefPubMed S. Belli, D. Santi, E. Leoni, E. Dall’Olio, F. Fanelli, M. Mezzullo, C. Pelusi, L. Roli, S. Tagliavini, T. Trenti, A.R. Granata, U. Pagotto, R. Pasquali, V. Rochira, C. Carani, M. Simoni, Human chorionic gonadotropin stimulation gives evidence of differences in testicular steroidogenesis in Klinefelter syndrome, as assessed by liquid chromatography-tandem mass spectrometry. Eur. J. Endocrinol. 174(6), 801–811 (2016). https://​doi.​org/​10.​1530/​EJE-15-1224 CrossRefPubMed
51.
Zurück zum Zitat F. Panimolle, C. Tiberti, S. Granato, A. Semeraro, D. Gianfrilli, A. Anzuini, A. Lenzi, A. Radicioni, Screening of endocrine organ-specific humoral autoimmunity in 47,XXY Klinefelter’s syndrome reveals a significant increase in diabetes-specific immunoreactivity in comparison with healthy control men. Endocrine 52(1), 157–164 (2016). https://doi.org/10.1007/s12020-015-0613-y CrossRefPubMed F. Panimolle, C. Tiberti, S. Granato, A. Semeraro, D. Gianfrilli, A. Anzuini, A. Lenzi, A. Radicioni, Screening of endocrine organ-specific humoral autoimmunity in 47,XXY Klinefelter’s syndrome reveals a significant increase in diabetes-specific immunoreactivity in comparison with healthy control men. Endocrine 52(1), 157–164 (2016). https://​doi.​org/​10.​1007/​s12020-015-0613-y CrossRefPubMed
52.
Zurück zum Zitat L. Langeron, P. Lamelin, G. Routier, Klinefelter syndrome and diabetes. J. Sci. Med. Lille 76(11), 440–444 (1958)PubMed L. Langeron, P. Lamelin, G. Routier, Klinefelter syndrome and diabetes. J. Sci. Med. Lille 76(11), 440–444 (1958)PubMed
53.
Zurück zum Zitat Y. Takeuchi, Y. Murata, J. Sintani, H. Masukawa, R. Nakamura, K. Oi, Y. Kato, M. Niinomi, Klinefelter’s syndrome accompanied by mixed connective tissue disease and diabetes mellitus. Intern. Med. 38(11), 875–881 (1999)CrossRefPubMed Y. Takeuchi, Y. Murata, J. Sintani, H. Masukawa, R. Nakamura, K. Oi, Y. Kato, M. Niinomi, Klinefelter’s syndrome accompanied by mixed connective tissue disease and diabetes mellitus. Intern. Med. 38(11), 875–881 (1999)CrossRefPubMed
54.
Zurück zum Zitat S.M. Milcou, B. Ionesco, A. Bucur, Glucide metabolism in Klinefelter’s disease. Rev. Fr. Endocrinol. Clin. 12(4), 305–314 (1971)PubMed S.M. Milcou, B. Ionesco, A. Bucur, Glucide metabolism in Klinefelter’s disease. Rev. Fr. Endocrinol. Clin. 12(4), 305–314 (1971)PubMed
55.
Zurück zum Zitat V. Esmann, J. Nielsen, G.B. Petersen, A case of Klinefelter’s syndrome with 48,XXXY and diabetes mellitus. Acta Med. Scand. 186(1-2), 27–33 (1969)PubMed V. Esmann, J. Nielsen, G.B. Petersen, A case of Klinefelter’s syndrome with 48,XXXY and diabetes mellitus. Acta Med. Scand. 186(1-2), 27–33 (1969)PubMed
56.
Zurück zum Zitat J. Nielsen, K. Johansen, H. Yde, Frequency of diabetes mellitus in patients with Klinefelter’s syndrome of different chromosome constitutions and the XYY syndrome. Plasma insulin and growth hormone level after a glucose load. J. Clin. Endocrinol. Metab. 29(8), 1062–1073 (1969). https://doi.org/10.1210/jcem-29-8-1062 CrossRefPubMed J. Nielsen, K. Johansen, H. Yde, Frequency of diabetes mellitus in patients with Klinefelter’s syndrome of different chromosome constitutions and the XYY syndrome. Plasma insulin and growth hormone level after a glucose load. J. Clin. Endocrinol. Metab. 29(8), 1062–1073 (1969). https://​doi.​org/​10.​1210/​jcem-29-8-1062 CrossRefPubMed
57.
Zurück zum Zitat J. Mirouze, C. Jaffiol, C. Bernard, E. Cartry, The prediabetes of Klinefelter’s syndrome. Diabete 14(2), 57–59 (1966)PubMed J. Mirouze, C. Jaffiol, C. Bernard, E. Cartry, The prediabetes of Klinefelter’s syndrome. Diabete 14(2), 57–59 (1966)PubMed
58.
Zurück zum Zitat I.M. Jackson, K.D. Buchanan, M.T. McKiddie, C.R. Prentice, Carbohydrate metabolism in Klinefelter’s syndrome. J. Endocrinol. 35(2), 169–172 (1966)CrossRefPubMed I.M. Jackson, K.D. Buchanan, M.T. McKiddie, C.R. Prentice, Carbohydrate metabolism in Klinefelter’s syndrome. J. Endocrinol. 35(2), 169–172 (1966)CrossRefPubMed
59.
Zurück zum Zitat K.L. Becker, D.L. Hoffman, L.O. Underdahl, H.L. Mason, Klinefelter’s syndrome. Clinical and laboratory findings in 50 patients. Arch. Intern. Med. 118(4), 314–321 (1966)CrossRefPubMed K.L. Becker, D.L. Hoffman, L.O. Underdahl, H.L. Mason, Klinefelter’s syndrome. Clinical and laboratory findings in 50 patients. Arch. Intern. Med. 118(4), 314–321 (1966)CrossRefPubMed
60.
Zurück zum Zitat J. Nielsen, Diabetes mellitus in parents of patients with Klinefelter’s syndrome. Lancet 287, 1376 (1966)CrossRef J. Nielsen, Diabetes mellitus in parents of patients with Klinefelter’s syndrome. Lancet 287, 1376 (1966)CrossRef
61.
Zurück zum Zitat A.P. Forbes, E. Engel, The high incidence of diabetes mellitus in 41 patients with gonadal dysgenesis, and their close relatives. Metabolism 12, 428–439 (1963)PubMed A.P. Forbes, E. Engel, The high incidence of diabetes mellitus in 41 patients with gonadal dysgenesis, and their close relatives. Metabolism 12, 428–439 (1963)PubMed
63.
Zurück zum Zitat K. Zuppinger, E. Engel, A.P. Forbes, L. Mantooth, J. Claffey, Klinefelter’s syndrome, a clinical and cytogenetic study in twenty-four cases. Acta Endocrinol. 54(Suppl 113), 115+ (1967) K. Zuppinger, E. Engel, A.P. Forbes, L. Mantooth, J. Claffey, Klinefelter’s syndrome, a clinical and cytogenetic study in twenty-four cases. Acta Endocrinol. 54(Suppl 113), 115+ (1967)
64.
Zurück zum Zitat M. Sagara, M. Nakasono, I. Makino, K. Takebe, Two cases of Klinefelter’s syndrome associated with diabetes mellitus, and analysing the clinical features of all domestic reported cases. J. Jpn. Diab. Soc. 28(5), 677–686 (1986) M. Sagara, M. Nakasono, I. Makino, K. Takebe, Two cases of Klinefelter’s syndrome associated with diabetes mellitus, and analysing the clinical features of all domestic reported cases. J. Jpn. Diab. Soc. 28(5), 677–686 (1986)
65.
Zurück zum Zitat K. Ota, T. Suehiro, Y. Ikeda, K. Arii, Y. Kumon, K. Hashimoto, Diabetes mellitus associated with Klinefelter’s syndrome: a case report and review in Japan. Intern. Med. 41(10), 842–847 (2002)CrossRefPubMed K. Ota, T. Suehiro, Y. Ikeda, K. Arii, Y. Kumon, K. Hashimoto, Diabetes mellitus associated with Klinefelter’s syndrome: a case report and review in Japan. Intern. Med. 41(10), 842–847 (2002)CrossRefPubMed
66.
Zurück zum Zitat C. Lichiardopol, M. Mota, C. Panus, Metabolic changes in Klinefelter syndrome. Rom. J. Intern. Med. 42(2), 415–422 (2004)PubMed C. Lichiardopol, M. Mota, C. Panus, Metabolic changes in Klinefelter syndrome. Rom. J. Intern. Med. 42(2), 415–422 (2004)PubMed
69.
Zurück zum Zitat M. Arcopinto, A. Salzano, E. Bossone, F. Ferrara, E. Bobbio, D. Sirico, O. Vriz, C. De Vincentiis, M. Matarazzo, L. Saldamarco, F. Sacca, R. Napoli, M. Iacoviello, V. Triggiani, A.M. Isidori, C. Vigorito, J. Isgaard, A. Cittadini, Multiple hormone deficiencies in chronic heart failure. Int. J. Cardiol. 184, 421–423 (2015). https://doi.org/10.1016/j.ijcard.2015.02.055 CrossRefPubMed M. Arcopinto, A. Salzano, E. Bossone, F. Ferrara, E. Bobbio, D. Sirico, O. Vriz, C. De Vincentiis, M. Matarazzo, L. Saldamarco, F. Sacca, R. Napoli, M. Iacoviello, V. Triggiani, A.M. Isidori, C. Vigorito, J. Isgaard, A. Cittadini, Multiple hormone deficiencies in chronic heart failure. Int. J. Cardiol. 184, 421–423 (2015). https://​doi.​org/​10.​1016/​j.​ijcard.​2015.​02.​055 CrossRefPubMed
72.
Zurück zum Zitat A. Salzano, A.M. Marra, F. Ferrara, M. Arcopinto, E. Bobbio, P. Valente, R. Polizzi, C. De Vincentiis, M. Matarazzo, L. Saldamarco, F. Sacca, R. Napoli, M.G. Monti, R. D’Assante, A.M. Isidori, J. Isgaard, N. Ferrara, P.P. Filardi, F. Perticone, C. Vigorito, E. Bossone, A. Cittadini, T.O.S.C. investigators, Multiple hormone deficiency syndrome in heart failure with preserved ejection fraction. Int. J. Cardiol. 225, 1–3 (2016). https://doi.org/10.1016/j.ijcard.2016.09.085 CrossRefPubMed A. Salzano, A.M. Marra, F. Ferrara, M. Arcopinto, E. Bobbio, P. Valente, R. Polizzi, C. De Vincentiis, M. Matarazzo, L. Saldamarco, F. Sacca, R. Napoli, M.G. Monti, R. D’Assante, A.M. Isidori, J. Isgaard, N. Ferrara, P.P. Filardi, F. Perticone, C. Vigorito, E. Bossone, A. Cittadini, T.O.S.C. investigators, Multiple hormone deficiency syndrome in heart failure with preserved ejection fraction. Int. J. Cardiol. 225, 1–3 (2016). https://​doi.​org/​10.​1016/​j.​ijcard.​2016.​09.​085 CrossRefPubMed
76.
Zurück zum Zitat W.C. Knowler, E. Barrett-Connor, S.E. Fowler, R.F. Hamman, J.M. Lachin, E.A. Walker, D.M. Nathan, G.Diabetes Prevention Program Research, Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 346(6), 393–403 (2002). https://doi.org/10.1056/NEJMoa012512 CrossRefPubMed W.C. Knowler, E. Barrett-Connor, S.E. Fowler, R.F. Hamman, J.M. Lachin, E.A. Walker, D.M. Nathan, G.Diabetes Prevention Program Research, Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 346(6), 393–403 (2002). https://​doi.​org/​10.​1056/​NEJMoa012512 CrossRefPubMed
Metadaten
Titel
Klinefelter syndrome, insulin resistance, metabolic syndrome, and diabetes: review of literature and clinical perspectives
verfasst von
Andrea Salzano
Roberta D’Assante
Liam M. Heaney
Federica Monaco
Giuseppe Rengo
Pietro Valente
Daniela Pasquali
Eduardo Bossone
Daniele Gianfrilli
Andrea Lenzi
Antonio Cittadini
Alberto M. Marra
Raffaele Napoli
Publikationsdatum
23.03.2018
Verlag
Springer US
Erschienen in
Endocrine / Ausgabe 2/2018
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-018-1584-6

Weitere Artikel der Ausgabe 2/2018

Endocrine 2/2018 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.