The ovine corticotropin-releasing hormone-stimulation test in type I diabetic patients and controls: Suggestion of mild chronic hypercortisolism
Abstract
We examined hypothalamic-pituitary-adrenal (HPA) axis function in insulin-dependent diabetic outpatients (N = 22) and age-, sex-, and weight-matched normal controls (N = 22). The evaluation included measurements of 9:00 AM fasting plasma cortisol and cortisol-binding globulin (CBG) levels, 24-hour urinary free cortisol (UFC) excretion, and plasma corticotropin and cortisol responses to intravenously administered ovine corticotropin-releasing hormone ([CRH] 1 microgram/kg given as a bolus at 8:00 PM). Diabetic patients had significantly elevated 9:00 AM plasma cortisol levels (mean +/- SE, 300.7 +/- 99.3 v 237.3 +/- 99.3 nmol/L, P < .04), higher 24-hour UFC excretion (313.2 +/- 112.6 v 244.2 +/- 69.3 nmol/24 h, P < .02), and greater cortisol responses to CRH infusion (time-integrated values: 49,408.2 +/- 11,289.8 v 40,217.9 +/- 7,228.6 nmol/L.120 min, P < .004; peak cortisol values: 529.7 +/- 107.6 v 438.7 +/- 77.3 nmol/L, P < .002) than controls. UFC excretion values were positively correlated with both 5-year averaged hemoglobin A1c level (P = .03) and total number of insulin units administered per day (P = .03). These results suggest that insulin-dependent diabetic outpatients have mild chronic hypercortisolism, which might influence the control of the disease and play a role in the development of its chronic complications.
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Hyperactivity of the HPA axis and hyperinsulinemia are frequently observed in patients with type 1 and type 2 diabetes and in patients with abdominal adiposity.
“Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in association with hyperinsulinemia is frequently found in patients with type 1 and type 2 diabetes mellitus and in subjects with abdominal adiposity.”
From Supraphysiological Hyperinsulinemia Acutely Increases Hypothalamic-Pituitary-Adrenal Secretory Activity in Humans (1999) · cites this paper as [6]
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- Authors
- Roy, M. S., Roy, A., Gallucci, W. T., Collier, B., Young, K., Kamilaris, T. C., & Chrousos, G. P.
- Affiliations
- National Institutes of Health (US)
- Venue
- Metabolism
- Publisher
- Elsevier BV
- Published
- 1993-06
- Volume
- 42
- Issue
- 6
- Pages
- 696-700
- ISSN
- 0026-0495 (ISSN-L)
- OpenAlex
- W1971381744
- Cited by
- 82
- References
- 28
- Citations by year
- 2024: 2 · 2023: 5 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 5 · 2012: 4
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 1 diabetes, hypothalamic-pituitary-adrenal axis, plasma cortisol, urinary free cortisol, corticosteroid-binding globulin, HbA1c, insulin dose, diabetes complications
- MeSH terms
- Adrenocortical Hyperfunction, Adrenocorticotropic Hormone, Adult, Animals, Corticotropin-Releasing Hormone, Diabetes Mellitus, Type 1, Female, Humans, Hydrocortisone, Male, Middle Aged, Outpatients, Sheep
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