Endocrine Abstracts

This work aimed at gathering own data on adrenal response to low-dose Synacthen test, CRH test and about periferal metabolism of cortisol in autoimmune type 1 diabetics with onset in adults. Seventy diabetics were investigated; age 44±10 years (mean±S.D.), age at diagnosis 28.5±10 years, disease duration 15±8 years, BMI 24.5±2.7 kg/cm², HbA1c 7.2±1.2%. The study was approved by the Ethical Committee. Adrenal reserve was tested by low-dose Synacthen test, pituitary function was tested by CRH test and periferal metabolism of cortisol was evaluated by suppresion of cortisol endogenous production by dexametasone administered orally and followed by cortisone acetate (25 mg) administration. We evaluated serum ACTH, serum cortisol, salivary cortisol, aldosterone, DHEA, cortisone during these tests, cortisol binding globulin, adrenal autoantibodies, thyroid function and metabolic paramerts of diabetics. We have found a subnormal response in 25% of patients (<500 nmol/l) of the serum cortisol during low-dose Synacthen test, accompanied by significantly decreased stimulated values of aldosterone and salivary cortisol. Basal serum cortisol, aldosterone, were significantly reduced, while ACTH, cortisol binding globulin and salivary cortisol did not differ. The CRH test displayed the low response in serum cortisol and ACTH as well in group of these patients. As compared with group of patients with sufficient response to Synacthen, the course of cortisol after cortisone acetate administration was delayed and significantly different from cortisol response in diabetics with hypocorticalism. The results indicate that the disorder of adrenocortical function occurs in all adrenocortical zones, on pituitary level and periferal adrenal metabolism could be change as well. These result may contribute to better understanding latent adrenal insuficiency adaptation in diabetics type 1.

The study was supported by grant no. NT 11 277 of the IGA MZCR.