Artículos de revistas
Cortisol hyporesponsiveness to the low dose ACTH test is a frequent finding in a pediatric population with type 1 diabetes mellitus
Fecha
2013Registro en:
Pediatric Diabetes 2013: 14: 429–434
doi: 10.1111/pedi.12021
Autor
Gaete, X.
Iñíguez Vila, Germán
Linares, J.
Avila, A.
Mericq, Verónica
Institución
Resumen
Introduction: In adults with type 1 diabetes mellitus (DM1), a 25% of risk of
hypocortisolism has been found through a low dose ACTH test with negative
antibodies suggesting other causes of hypothalamic–pituitary–adrenal axis
dysfunction.
Aim: To evaluate adrenal function in pediatric patients with DM1 and
correlate the results with the frequency of hypoglycemia and metabolic
control.
Methods: Sixty-nine patients were enrolled, age 12.3 (5.7–18.1); 50 boys and
19 girls. A 20% had additional autoimmune diseases. Mean hemoglobin A1c
(HbA1c) was 8.1% and insulin dose was 1.14 U/kg/d. After an overnight fast,
a low dose ACTH test (1 μg) was performed. Basal and stimulated cortisol
concentrations, DHEAS, and plasma renin activity (PRA) were measured. A
cortisol response post-ACTH below 18 μg/dL was considered abnormal.
Results: 58% of the tested patients had an abnormal response to ACTH test.
These patients also had lower DHEAS concentrations, but were not different
in diabetes duration, HbA1C, severe hypoglycemia, ACTH, or PRA
concentrations compared to those who had a normal cortisol post-ACTH.
One patient out of 59, had a positive anti-21-hydroxylase antibody (21OHA)
and presented a poor response to ACTH.
Conclusions: We found a significant proportion of our patients having a
subnormal cortisol response independent of the presence of anti-adrenal cell
antibodies.We did not find a correlation with metabolic control, probably due
to the good metabolic control of this group. The absence of 21OHA does not
rule out subclinical hypocortisolism in this population. Our results suggest
testing adrenal function in children with DM1.