Levels of adrenomedullin during low dose Synacthen test in diabetics type 1
Katerina Simunkova1,3, Radovan Bilek1, Richard Hampl1, Vaclav Zamrazil2, Denisa Janickova-Zdarska2, Martin Hill1 & Karel Vondra1
The aim of the study was to obtain the basic data about adrenomedullin after 1 μg ACTH stimulation.
Adrenomedullin has direct effect on adrenal cortex secretion, therefore we studied the changes of its concentrations during ACTH stimulation in diabetic patients suspected of hypocorticalism.
Thirty-two diabetics type 1 (DM1) were investigated; 16 with and 16 without autoimmune thyroditis (AIT); age 44±10 years (mean±S.D.), age at diagnosis of DM1 28.5±10 years, disease duration 15±8 year, BMI 24.5±2.7 kg/cm2, HbA1c 7.2±1.2%. Control group had eight healthy subjects; age 27±6 years, BMI 21.7±2.3 kg/cm2. Neither group showed laboratory signs of adrenal autoimmunity. The study was approved by local ethical committee.
Adrenocortical reserve was tested by 1 μg ACTH stimulus. Serum cortisol, adrenomedullin were determined in times 0 (basal) and after 20th, 30th, 40th, 60th min.
We divided DM1 patients according to their response during low dose ACTH test to the groups with low (LR) and normal (NR) response and control group (C). Maximum stimulated value of cortisol in serum above 500 nmol/l excluded adrenocortical insufficiency.
After ACTH stimulation, levels of adrenomedullin were increased in DM1 with LR as compared with other groups, P<0.005. The peak levels of adrenomedullin were found in 30th min in both groups of diabetics, LR and NR as well. Stimulated levels of adrenomedullin did not differ from basal levels in DM1 with AIT. Stimulated levels of adrenomedullin in DM1 with AITD LR did not differ from NR and C.
In conclusion, we found distinct difference in adrenomedullin levels between patients with isolated diabetes type l and diabetics with AIT, independently on cortisol response during Synacthen test. These results may contribute to better understanding of adaptation to latent adrenocortical insuficiency in diabetics type 1.
The study was supported by grant No. 9834-4, 9831-4, 10215-3 IGAMZCR, NR 9154-3.