Cortisol secretion in patients with type 2 diabetes: relationship with chronic complications.
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.
Chiodini
Iacopo
I
Endocrine Unit, Department of Medical Sciences, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy. ichiodini@katamail.com
Adda
Guido
G
Scillitani
Alfredo
A
Coletti
Francesca
F
Morelli
Valentina
V
Di Lembo
Sergio
S
Epaminonda
Paolo
P
Masserini
Benedetta
B
Beck-Peccoz
Paolo
P
Orsi
Emanuela
E
Ambrosi
Bruno
B
Arosio
Maura
M
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
D015415:Biomarkers; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone