title: Cortisol secretion in patients with type 2 diabetes: relationship with chronic complications.
abstract: OBJECTIVE
  The presence of an enhanced cortisol secretion in patients with type 2 diabetes is debated. In type 2 diabetic subjects, cortisol secretion was found to be associated with the complications and metabolic control of diabetes. We evaluated cortisol secretion in 170 type 2 diabetic subjects and in 71 sex-, age-, and BMI-matched nondiabetic subjects.
  
  
  METHODS
  In all subjects, we evaluated ACTH at 8:00 a.m. in basal conditions and serum cortisol levels at 12:00 p.m. (F24) and at 9:00 a.m. after a 1-mg overnight dexamethasone suppression test and 24-h urinary free cortisol (UFC). In diabetic patients, we evaluated the presence of chronic complications (incipient nephropathy, asymptomatic neuropathy, background retinopathy, and silent macroangiopathy). Patients were subdivided according to the absence (group 1, n = 53) or presence (group 2, n = 117) of diabetes complications.
  
  
  RESULTS
  In group 2, UFC (125.2 +/- 4.6 nmol/24 h) and F24 (120.6 +/- 4.1 nmol/l) were higher than in group 1 (109.2 +/- 6.8 nmol/24 h, P = 0.057, and 99.7 +/- 6.1 nmol/l, P = 0.005, respectively) and in nondiabetic patients (101.7 +/- 5.9 nmol/24 h, P = 0.002, and 100.3 +/- 5.3 nmol/l, P = 0.003, respectively). In diabetic patients, the number of complications was associated with F24 (R = 0.345; P < 0.0001) and diabetes duration (R = 0.39; P < 0.0001). Logistic regression analysis showed that the presence of diabetes complications was significantly associated with F24, sex, duration of diabetes, and glycated hemoglobin.
  
  
  CONCLUSIONS
  In type 2 diabetic subjects, hypothalamic-pituitary-adrenal activity is enhanced in patients with diabetes complications and the degree of cortisol secretion is related to the presence and number of diabetes complications.
authors.affiliation: Endocrine Unit, Department of Medical Sciences, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy. ichiodini@katamail.com
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
authors.forename: Guido
authors.initials: G
authors.lastname: Adda
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.forename: Francesca
authors.initials: F
authors.lastname: Coletti
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Sergio
authors.initials: S
authors.lastname: Di Lembo
authors.forename: Paolo
authors.initials: P
authors.lastname: Epaminonda
authors.forename: Benedetta
authors.initials: B
authors.lastname: Masserini
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Emanuela
authors.initials: E
authors.lastname: Orsi
authors.forename: Bruno
authors.initials: B
authors.lastname: Ambrosi
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003907:Dexamethasone; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D012044:Regression Analysis
chemical_list: D015415:Biomarkers; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone