Endocrine Abstracts

This work aimed to evaluate pituitary–adrenal axis and tissue metabolism of cortisol in patients with long standing type one diabetes.

Fifty patients with diabetes type 1 were investigated; age 38±10 years (mean±S.D.), age at diagnosis 25.5±10 years, disease duration 15±8 years, BMI 24.5±2.7 kg/cm², HbA1c 7.2±1.2%. Control group consisted of 40 healthy volunteers.

The study was approved by the Ethical Committee.

Adrenocortical function had been tested by three different tests – Synacthen test, CRH test, and peripheral metabolism of cortisol had been evaluated by cortisone acetate (25 mg) administration and analysis of cortisol:cortisone ratio.

We evaluated serum ACTH, serum cortisol, serum cortisone during these tests, at the basal level cortisol binding globulin, aldosterone, and metabolic parameters of diabetics. Patients with positivity of adrenal autoantibodies, pituitary autoantibodies, thyroid disorders were excluded from group of these patients.

In 15% of patients we have found a subnormal response (<500 nmol/l) of the serum cortisol during low-dose Synacthen test, accompanied by significantly decreased stimulated values of aldosterone. Basal serum cortisol, aldosterone has been significantly reduced, while ACTH, cortisol binding globulin did not change. The CRH test displayed the low response in serum cortisol and hyperactivity in ACTH in this group of patients. The course of cortisol after cortisone acetate administration was delayed and significantly different in diabetic patients compare to controls.

Conclusion: At least in a part of patients with type 1 diabetes mellitus a reduced secretion of both cortisol and aldosterone after ACTH stimulation could be observed. In diabetic patients peripheral conversion cortisol-cortisone is disturbed as well. These results may contribute to better understanding to pituitary–adrenal adaptation in diabetes type one.