内分泌，代謝性疾患と消化管

Relationship between Endocrine and Metabolic Disorders and Gastrointestinal Tract

　今世紀の初めに内分泌という概念が生れてから3/4世紀を経たが，最近20年間におけるこの領域の進歩は著しい．すなわち，従来知られていたホルモンのほかに新しいホルモンの同定が行なわれるとともに，体液中に微量に存在する各種ホルモンの測定が可能となり，血中におけるホルモンの動態が漸次明らかにされている．一方，近年における生化学の進歩に伴い，種々の代謝異常の病態生理が解明されている．各種内分泌異常は終局において代謝異常とともに体内の組織における代謝上の障害を惹き起こすが，消化管も例外ではない．

　これらの代謝の障害は消化管の機能的な異常を生じ，さらに進むと器質的な変化を招来することになり，これに対応する消化管症状を呈するので，この問題は重要なテーマである．

　As endocrine diseases as well as metabolic disorders induce derangements in the metabolism in the various tissues, they might cause gastrointestinal symptoms as a result of functional or organic changes of the digestive tract.

　Anorexia, nausea, vomiting, abdominal pain or abnormalities of stool are prominent in the diseases of the pituitary, adrenal gland, thyroid andparathyroid. Awareness of hyperparathyroidism should be emphasized among these endocrine diseases, since a higher incidence of peptic ulcer is reported in this situation. In diabetes mellitus, gastroinrestinal symptoms such as abdominal pain, diarrhea and constipation are often observed as a secondary change of the metabolic disorder and diabetic angiopathy. Multiple ulcers and watery diarrhea are most prominent in Zollinger-Ellison syndrome and WDHA syndrome, respectively, while there are mild gastrointestinal symptoms in the patients with insulinoma or glucagonoma. Enteroglucagonoma or carcinoid, which is a functional tumor of the gastrointestinal tract, is associated with obstinate constipation, diarrhea or steatorrhea. Hypoglycemia may cause a massive hemorrhage of the gastrointestinal tract in addition to nausea or vomiting. Diarrhea and malabsorption are reported in some of the defects of protein metabolism. It is well known that type I and type V hyperlipidemia are associated with recurrent acute abdominal pain. Diarrhea, abdominal pain and gastrointestinal bleeding are observed in some of vitamin deficiencies. Acute intermittent porphyria is characterized by periodic attacks of abdominal pain, obstinate constipation and psychotic behavior. From these considerations it is emphasized that the relationship between endocrine or metabolic disorders and gastrointestinal tract should always be kept in mind in the clinical medicine of the digestive tract.