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Relationship between type 2 diabetes mellitus and hypothalamic-pituitary-adrenal axis.

Summary of "Relationship between type 2 diabetes mellitus and hypothalamic-pituitary-adrenal axis."


INTRODUCTION:
Hypercortisolism often leads to impaired glucose tolerance or type 2 diabetes mellitus. On the other hand, changes in the regulation of hypothalamic-pituitary-adrenal axis become a matter of debate in patients with type 2 diabetes mellitus/metabolic syndrome. PATIENTS, MATERIALS, AND
METHODS:
Authors assessed the hypothalamic-pituitary-adrenal axis activity and subclinical Cushing's syndrome occurrence in 50 patients with type 2 diabetes mellitus in comparison to 25 sex-, age-, and BMI-matched control nondiabetic subjects. 1 mg dexamethasone suppression test with NIH recommended cut-off level for adrenal incidentaloma (serum cortisol after suppression > 138 nmol/l) was used to postulate the diagnosis of subclinical hypercortisolism.
RESULTS:
There were no significant differences in serum ACTH, DHEA-S, baseline serum cortisol as well as serum cortisol after suppression of 1 mg dexamethasone/subclinical Cushing's syndrome prevalence in both diabetic and control groups (18 vs. 24% respectively, p = 0.54) and there was no relation to the type of treatment (OAD vs. insulin) in group of diabetics. When divided according to age, diabetics older than 60 years suppressed their serum cortisol significantly worse than their age-related controls (99.3 vs. 85.5 nmol/l, p = 0.0001). Furthermore, diabetics did not show an age-related decrease in DHEA-S levels, whereas controls did (r = -0.302, p = 0.033; r = -0.596, p = 0.0017 respectively). Within the group of diabetics, a positive correlation between C-peptid levels and baseline serum cortisol/DHEA-S levels was detected as well (r = 0.445, p = 0.001 and r = 0.339, p = 0.017 respectively).
CONCLUSION:
Our data show relatively high but comparable lack of cortisol suppression in both diabetic and control groups; however, we consider the subclinical Cushing's syndrome diagnose to be criteria dependent. There is no dependence of type of diabetes treatment (OAD vs. insulin) on HPA axis activity. Our results might indicate the possible role of cortisol in pathogenesis of type 2 diabetes mellitus in patients with metabolic syndrome as well as possible protective role of DHEA-S within the frame of secondary contraregulatory mechanisms aimed to improve insulin sensitivity and reduce the hyperinsulinemia.

Affiliation

1st Department of Internal Medicine, L. Pasteur University Hospital and Medical Faculty of P. J. Šafárik University, Košice, Slovakia, felsoci@hotmail.com.

Journal Details

This article was published in the following journal.

Name: Wiener klinische Wochenschrift
ISSN: 1613-7671
Pages:

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Medical and Biotech [MESH] Definitions

A subclass of DIABETES MELLITUS that is not INSULIN-responsive or dependent (NIDDM). It is characterized initially by INSULIN RESISTANCE and HYPERINSULINEMIA; and eventually by GLUCOSE INTOLERANCE; HYPERGLYCEMIA; and overt diabetes. Type II diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop KETOSIS but often exhibit OBESITY.

The time period before the development of symptomatic diabetes. For example, certain risk factors can be observed in subjects who subsequently develop INSULIN RESISTANCE as in type 2 diabetes (DIABETES MELLITUS, TYPE 2).

The interactions between the anterior pituitary and adrenal glands, in which corticotropin (ACTH) stimulates the adrenal cortex and adrenal cortical hormones suppress the production of corticotropin by the anterior pituitary.

A subtype of DIABETES MELLITUS that is characterized by INSULIN deficiency. It is manifested by the sudden onset of severe HYPERGLYCEMIA, rapid progression to DIABETIC KETOACIDOSIS, and DEATH unless treated with insulin. The disease may occur at any age, but is most common in childhood or adolescence.

A type of diabetes mellitus that is characterized by severe INSULIN RESISTANCE and LIPODYSTROPHY. The latter may be generalized, partial, acquired, or congenital (LIPODYSTROPHY, CONGENITAL GENERALIZED).

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