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Adrenocortical insufficiency and diabetes mellitus type 1


Authors: Kateřina Šimůnková 1,2;  Karel Vondra 1
Authors‘ workplace: Endokrinologický ústav, Praha 1;  Univerzita Karlova v Praze, 1. lékařská fakulta, III. interní klinika VFN 2
Published in: Čas. Lék. čes. 2010; 149: 120-124
Category: Review Article

Overview

Adrenocortical disorders represents an important problem in patients with type 1 diabetes mellitus and therefore many physicians are concerned with this issue. The causes of adrenocortical insufficiency include both autoimmunity and dysregulation related to insufficiently compensated diabetes. Early diagnosis of hypocorticism remains doubtful. Diagnostic approaches are not standardized or unified and especially their evaluation and interpretation are a matter of discussion.

Treatment of proven hypocorticism, notably of the subclinical form in diabetic patients, remains questionable. Modes of substitution used presently cannot mimic fully diurnal rhythm of glucocorticoid secretion in spite of newly developed drug forms. The risk of glucocorticoid overdose persists, and insulinotherapy need to be adjusted permanently.

Key words:
Addison’s disease, adrenocortical insufficiency, diabetes mellitus type 1, low-dose ACTH test, autoantibodies against 21 hydroxylase, autoimmune hypophysitis, autoimmune polyglandular syndrome, 11ß-hydroxysteroid dehydrogenase type 1.


Sources

1. Vondra K, et al. Diabetes mellitus dospělých diabetiků 1. typu v závislosti na přítomné autoimunitní tyroiditidě vykazuje imunologické, funkční a klinické odlišnosti. Čas Lék čes 2007; 146: 267–272.

2. Kahaly JG, et al. Diabetes mellitus typ 1 als Teil des polyglandularen Autoimmunsyndroms. Diabetes Stoffwechsel 1997; 6: 19–27.

3. Betterle C. Addison’s disease and autoimmune polyglandular syndrome. In: Geenen V, Chrosus G, Immunoendocrinology in health and disease. New York: Marcel Dekker Inc. Publisher 2004.

4. Betterle C, et al. Adrenal cortex autoantibodies in subjects with normal adrenal function. Best Pract Res Clin Endocrinol Metab 2005; 19: 85–99.

5. Coco G, et al. Estimated risk for developing autoimmune Addison’s disease in patients with adrenal cortex autoantibodies. J Clin Endocrinol Metab 2006; 91: 1637–1645.

6. Laureti S, et al. Etiological diagnosis of primary adrenal insufficiency using an original flowchart of immune and biochemical markers. J Clin Endocrinol Metab 1998; 83: 3163–3168.

7. Schatz DA, et al. Autoimmune polyglandular syndrome. II: Clinical syndrome and treatment. Endocrinol Metab Clin North Am 2002; 31: 339–52.

8. Marcus-Perlman Y, et al. Low-dose ACTH (1 microg) salivary test: a potential alternative to the classical blood test. Clin Endocrinol (Oxf) 2006; 64: 215–218.

9. Betterle C, et al. I. Adrenal cortex and steroid 21-hydroxylase autoantibodies in adult patients with organ-specific autoimmune diseases: markers of low progression to clinical Addison’s disease. J Clin Endocrinol Metab 1997a; 82: 932–938.

10. Betterle C, et al. II. Adrenal cortex and steroid 21-hydroxylase autoantibodies in children with organ-specific autoimmune diseases: markers of high progression to clinical Addison’s disease. J Clin Endocrinol Metab 1997b; 82: 939–942.

11. Betterle C, et al. Autoimmune adrenal insufficiency and autoimmune polyendocrine Syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev 2002; 23: 327.

12. Liu E, et al. Type 1A diabetes mellitus – associated autoimmunity. Endocrinol Metab Clin North Am 2002; 31(2): 391–410.

13. Falorni A, et al. Autoantibodies in autoimmune polyendocrine syndrome type II. Endocrinol Metab Clin North Am 2002; 31(2): 369–389.

14. De Bellis A, et al. Prolactin and autoimmunity. Pituitary 2005; 8: 25–30.

15. Smans LC, et al. Partial recovery of adrenal function in a patient with autoimmune Addisons disease. J Endocrinol Invest 2008; 31: 672–674.

16. Brauckhoff M, et al. Critical size of residual adrenal tissue and recovery from impaired early postoperative adrenocortical function after subtotal bilateral adrenalectomy. Surgery 2003; 134(6): 1020–1027; discussion 1027–1028.

17. Guichelaar MM, et al. Transient adrenocortical insufficiency following traumatic bilateral adrenal hemorrhage. J Trauma 2004; 56(5): 1135–1137.

18. Yu L, et al. DRB104 and DQ alleles: expression of 21-hydroxylase autoantibodies and risk of progression to Addison’s disease. J Clin Endocrinol Metab 1999; 84: 328–335.

19. Barker JM, et al. Endocrine and immunogenetic testing in individuals with type 1 diabetes and 21-hydroxylase autoantibodies: Addison’s disease in a high-risk population. J Clin Endocrinol Metab 2005; 90: 128 – 134.

20. Barker JM. Type 1 Diabetes – associated autoimmunity: Natural history, genetic associations, and screening. J Clin Endocrinol Metab 2006; 91: 1210–1217.

21. Dittmar M, et al. Polyglandular autoimmune syndromes: immunogenetics and long-term follow-up. J Clin Endocrinol Metab 2003; 88: 2983–2992.

22. Betterle C, et al. Premature ovarian failure: autoimmunity and natural history. Clin Endocrinol (Oxf) 1993; 39: 35–43.

23. Wilkin TJ. Receptor autoimmunity in endocrine disorders. N Engl J Med 1990; 323: 1318–1324.

24. Laureti S, et al. Low dose (1 microg) ACTH test in the evaluation of adrenal dysfunction in pre-clinical Addison’s disease. Clin Endocrinol (Oxf) 2000; 53(1): 107–115.

25. Giordano R, et al. Adrenal sensitivity to adrenocorticotropin 1–24 is reduced in patients with autoimmune polyglandular syndrome. J Clin Endocrinol Metab 2004; 89: 675–680.

26. Giordano R, et al. Corticotrope hypersecretion coupled with cortisol hypo-responsiveness to stimuli is present in patients with autoimmune endocrine diseases: evidence for subclinical primary hypoadrenalism. Eur J Endocrinol 2006; 155: 421–428.

27. Wick G, et al. Immunoendocrine communication via the hypothalamo-pituitary-adrenal axis in autoimmune diseases. Endocr Rev 1993; 14: 539–563.

28. Rotondi M, et al. Elevated serum interferon-γ-inducible chemokine-10/CXC chemokine Ligand-10 in autoimmune primary adrenal insufficiency and in vitro expression in human adrenal cells primary cultures after stimulation with proinflammatory cytokines. J Clin Endocrinol Metab 2005; 90: 2357–2363.

29. Ehrhart-Bornstein M, et al. Intraadrenal interactions in the regulation of adrenocortical steroidogenesis. Endocr Rev 1998; 19: 101–143.

30. Aimaretti G, et al. Hypopituitaric patients with corticotropin insufficiency show marked impairment of the cortisol response to ACTH (1–24) independently of the duration of the disease. J Endocrinol Invest 2003; 26: 49–55.

31. Caturegli P. Autoimmune hypophysitis: An underestimated disease in search of its autoantigen(s). J Clin Endocrinol Metab 2007; 92: 2038–2040.

32. Weetman PA. Autoimmune diseases in endocrinology. Totowa, NJ: Humana Press 2008; 370–371.

33. Chan O, et al. Insulin alone increases hypothalamo-pituitary-adrenal activity, and diabetes lowers peak stress response. Endocrinology 2005; 146: 1382–1390.

34. Chan O, et al. Diabetes and the hypothalamo-pituitary-adrenal (HPA) axis. Minerva Endocrinol 2003; 28(2): 87–102.

35. Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure and its component syndromes in diabetes. Diabetes 2005; 54: 3592–3601.

36. Davis MR, et al. Counterregulatory adaptation to recurrent hypoglycemia in normal humans. J Clin Endocrinol Metab 1991; 73: 995–1001.

37. McGregor VP, et al. Elevated endogenous cortisol reduces autonomic neuroendocrine and symptom responses to subsequent hypoglycemia. Am J Physiol Endocrinol Metab 2002; 282: E770–E777.

38. Tomlinson JW, et al. 11ß-hydroxysteroid dehydrogenase type 1: A tissue-specific regulator of glucocorticoid response. Endocr Rev 2004; 25: 831–866.

39. Seckl JR, et al. Glucocorticoids and 11beta-hydroxysteroid dehydrogenase in adipose tissue. Recent Prog Horm Res 2004; 59: 359.

40. Rask E, et al. Tissue-specific dysregulation of cortisol metabolism in human obesity. J Clin Endocrinol Metab 2001; 86: 1418–1421.

41. Andrews CR, et al. Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. J Clin Endocrinol Metab 2002; 87: 5587–5593.

42. Rask E, et al. Tissue specific changes in peripheral cortisol metabolism in obese women incerased adipose 11beta HSD1 activity. J Clin Endocrinol Metab 2002; 87: 3330–3336.

43. Stewart PM. Tissue-specific Cushing’s syndrom uncovers a new target in treating the metabolic syndrome – 11ß-hydroxysteroid dehydrogenase type 1. Clin Med 2005; 5: 142–146.

44. Krebs M, et al. Free fatty acids inhibit the glucose stimulated increase of intramuscular glucose 6 phosphatase concetration in humans. J Clin Endocrinol Metab 2001; 86: 2153–2160.

45. Walker EA, et al. 11beta HSD1 regulation by intracellular glucose 6 phosphate provides evidence for a novel link between glucose metabolism and hypothalamo-pituitary adrenal axis function. J Biol Chem 2007; 282: 27030–27036.

46. Ferguson SE, et al. The effects of different culture media, glucose, pyridine nucleotides and adenosine on the activity of 11beta-hydroxysteroid dehydrogenase in rat Leydig cells. Mol Cell Endocrinol 1999; 158: 37–44.

47. Wake DJ, et al. 11beta-hydroxysteroid dehydrogenase type 1 in obesity and the metabolic syndrome. Mol Cell Endocrinol 2004; 215: 45–54.

Tato práce vznikla za podpory grantového projektu IGA MZ ČR NR/9154-3.

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