title: Influence of the hypothalamic-pituitary-adrenal axis dysregulation on the metabolic profile of patients affected by diabetes mellitus-associated late onset hypogonadism.
abstract: OBJECTIVE
  Functional hypercortisolism (FH) is generated by clinical states able to chronically activate the hypothalamic-pituitary-adrenal (HPA) axis [e.g. diabetes mellitus (DM)]. No study has evaluated FH influence in worsening the metabolic profile of male patients affected by DM-associated hypogonadism. In this retrospective work, we assess the possible association between HPA axis-dysregulation and cardiovascular risk factors in men simultaneously affected by DM and late-onset hypogonadism (LOH).
  
  
  RESULTS
  Fourteen DM and LOH subjects affected by FH (Hypercort-DM-LOH) and fourteen DM and LOH subjects who were not suffering from FH (Normocort-DM-LOH) were retrospectively considered. Clinical, hormonal and metabolic parameters were retrieved. All metabolic parameters, except for systolic blood pressure, were significantly worse in Hypercort-DM-LOH than in Normocort-DM-LOH. After adjustment for body mass index, waist and total testosterone, Hypercort-DM-LOH subjects showed significantly worse metabolic parameters than Normocort-DM-LOH ones. In Normocort-DM-LOH, no significant correlation between general/hormonal parameters and metabolic variables was present. In Hypercort-DM-LOH, positive and significant correlations of cortisol area under the curve (AUC) after corticotropin releasing hormone with glycemia, triglycerides and blood pressure were evident; on the other hand, negative and significant correlation was present between cortisol AUC and high density lipoprotein (HDL) cholesterol. The associations of AUC cortisol with glycemia, HDL cholesterol and diastolic blood pressure (DBP) were further confirmed at quantile regression after adjustment for therapy.
  
  
  CONCLUSIONS
  FH may determine a worsening of the metabolic profile in DM-associated hypogonadism.
authors.affiliation: Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tirabassi
authors.affiliation: Department of Economics and Social Sciences, Polytechnic University of Marche, Ancona, Italy.
authors.forename: F M
authors.initials: FM
authors.lastname: Chelli
authors.affiliation: Department of Economics and Social Sciences, Polytechnic University of Marche, Ancona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ciommi
authors.affiliation: Andrology, Pathophysiology of Reproduction and Endocrine Diagnosis Unit, Policlinic Umberto I, University of Rome "La Sapienza", Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lenzi
authors.affiliation: Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy. Electronic address: g.balercia@univpm.it.
authors.forename: G
authors.initials: G
authors.lastname: Balercia
mesh_terms: D000304:Adrenal Cortex Function Tests; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D007006:Hypogonadism / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism* / Q000503:physiopathology; D008055:Lipids / Q000097:blood*; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids; D006854:Hydrocortisone
keywords: Cardiovascular risk factors; Diabetes mellitus; Hypothalamic–pituitary–adrenal (HPA) axis; Late onset hypogonadism