title: Adrenocortical function in young adults with diabetes mellitus type 1.
abstract: In 75 young adults with diabetes mellitus type 1 (DM 1) we have performed a cross-sectional study to gain more information about their adrenocortical function. We have found in a surprisingly large portion of patients (25%) a subnormal response (<500 nmol/L, low responders) of the serum cortisol during low-dose Synacthen test, accompanied by significantly decreased stimulated values of aldosterone and salivary cortisol. Basal serum cortisol, aldosterone, and dehydroepiandrosterone sulphate (in women only) were significantly reduced in low responders as well, while ACTH, cortisol binding globulin, plasma renin activity, urinary free cortisol/24h, and salivary cortisol did not differ. The results indicate that the disorder of adrenocortical function in low responders occurs in all adrenocortical zones. The patients with the highest risk in respect to revealed hypocorticalism were DM 1 with autoimmune thyroiditis, 13 out of 36 in contrast to 5 out of 39 suffered from isolated form of DM 1, with onset around 30 years, independently on sex. The biorhythm of salivary cortisol in low responders under real-life conditions did not significantly differ from normal responders, except of the decreased values in the morning. Antibodies against 21-hydroxylase and adrenal cortex were negative in the entire group of diabetics studied. In conclusion, this is the first study to demonstrate in as much as 25% of young adults with DM 1 patients without any signs of adrenal autoimmunity decreased both basal and stimulated serum cortisol and aldosterone levels, implying existence of subclinical primary hypocorticalism.
authors.affiliation: Institute of Endocrinology, Narodni trida 8, 116 94 Prague, Czech Republic. ksimunkova@endo.cz
authors.forename: Katerina
authors.initials: K
authors.lastname: Simunkova
authors.forename: Richard
authors.initials: R
authors.lastname: Hampl
authors.forename: Martin
authors.initials: M
authors.lastname: Hill
authors.forename: Lubomir
authors.initials: L
authors.lastname: Kriz
authors.forename: Pavlina
authors.initials: P
authors.lastname: Hrda
authors.forename: Denisa
authors.initials: D
authors.lastname: Janickova-Zdarska
authors.forename: Vaclav
authors.initials: V
authors.lastname: Zamrazil
authors.forename: Jana
authors.initials: J
authors.lastname: Vrbikova
authors.forename: Karel
authors.initials: K
authors.lastname: Vondra
mesh_terms: D000302:Adrenal Cortex / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D001786:Blood Glucose / Q000378:metabolism; D002352:Carrier Proteins / Q000097:blood; D002940:Circadian Rhythm / Q000502:physiology; D003430:Cross-Sectional Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000378:metabolism* / Q000652:urine; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism* / Q000652:urine; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D018709:Statistics, Nonparametric; D055815:Young Adult
chemical_list: D000324:Adrenocorticotropic Hormone; D000450:Aldosterone; D001786:Blood Glucose; D002352:Carrier Proteins; D019314:Dehydroepiandrosterone Sulfate; D006442:Glycated Hemoglobin; D006854:Hydrocortisone; D012083:Renin; C027091:cortisol binding globulin