Urinary free cortisol and its nyctohemeral variation in adolescents and young adults with IDDM: relation to endothelin 1 and indices of diabetic angiopathy.
The existence of a hyperactive hypothalamic pituitary adrenal (HPA) axis in diabetics and its relevance to diabetic complications has been controversial. In this study we determined the 24 hour urinary excretion of free cortisol (UFC), its nyctohemeral variation and its relation to indices of diabetic angiopathy. In 130 subjects with IDDM, aged 15.2+/-4.8 years and diabetes duration 7.3+/-5 years, and in 48 controls of comparable age, UFC, urinary endothelin (UET1), urinary albumin, HbA1c, and plasma renin were determined. The total 24-hour UFC excretion was greater in diabetics than in controls (p=0.002) and also greater in diabetic males than in females (p=0.006), while no sex difference was detected in the controls. Day UFC excretion was greater than night UFC excretion (p<0.001) in all subjects. UFC correlated to carotid intimal plus medial thickness (r=0.48, p=0.002), urinary albumin (r=0.50, p<0.001), UET1 (r=0.56, p<0.001), diastolic, systolic and mean blood pressure (r=0.27, p=0.003; r=0.41, p<0.001; r=0.34, p<0.001), BMI (r=0.50, p<0.001), serum creatinine (r=0.35, p<0.001), total cholesterol (r= -0.19, p=0.036), HDL (r= -0.22, p=0.038), LDL (r= -0.23, p=0.032), age (r=0.61, p<0.001) and diabetes duration (r=0.37, p<0.001). These results suggest that hyperactivity of the HPA axis or of the adrenals, due to chronic stress, hypoglycemic episodes or other factors, possibly contributes to the establishment or progression of diabetic micro- or macroangiopathy.
Dacou-Voutetakis
C
C
Diabetes Center, First Pediatric Department Athens University Aghia Sophia Children's Hospital, Greece.
Peppa-Patrikiou
M
M
Dracopoulou
M
M
D000293:Adolescent; D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000652:urine*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000652:urine*; D019332:Endothelin-1 / Q000652:urine*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D008297:Male; D012016:Reference Values; D012727:Sex Characteristics; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography
D019332:Endothelin-1; D006854:Hydrocortisone