Cortisol Secretion in Patients With Type 2 Diabetes

Relationship with chronic complications

  1. Iacopo Chiodini, MD1,
  2. Guido Adda, MD2,
  3. Alfredo Scillitani, MD3,
  4. Francesca Coletti, MD2,
  5. Valentina Morelli, MD2,
  6. Sergio Di Lembo, MD2,
  7. Paolo Epaminonda, MD2,
  8. Benedetta Masserini, MD2,
  9. Paolo Beck-Peccoz1,
  10. Emanuela Orsi, MD1,
  11. Bruno Ambrosi4 and
  12. Maura Arosio12
  1. 1Endocrine Unit, Department of Medical Sciences, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy
  2. 2Department of Endocrinology, San Giuseppe-Fatebenefratelli Hospital, A.Fa.R., Milan, Italy
  3. 3Unit of Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Foggia, Italy
  4. 4Unit of Endocrinology, Department of Medical and Surgical Sciences, University of Milan, IRCCS Policlinico San Donato Institute, San Donato Milanese, Milan, Italy
  1. Address correspondence and reprint requests to Iacopo Chiodini, MD, Endocrine Unit, Department of Medical Sciences, University of Milan, Fondazione Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy, via Francesco Sforza 35, 20122 Milan, Italy. E-mail: ichiodini{at}


OBJECTIVE—The presence of an enhanced cortisol secretion in patients with type 2 diabetes is debated. In type 2 diabetic subjects, cortisol secretion was found to be associated with the complications and metabolic control of diabetes. We evaluated cortisol secretion in 170 type 2 diabetic subjects and in 71 sex-, age-, and BMI-matched nondiabetic subjects.

RESEARCH DESIGN AND METHODS—In all subjects, we evaluated ACTH at 8:00 a.m. in basal conditions and serum cortisol levels at 12:00 p.m. (F24) and at 9:00 a.m. after a 1-mg overnight dexamethasone suppression test and 24-h urinary free cortisol (UFC). In diabetic patients, we evaluated the presence of chronic complications (incipient nephropathy, asymptomatic neuropathy, background retinopathy, and silent macroangiopathy). Patients were subdivided according to the absence (group 1, n = 53) or presence (group 2, n = 117) of diabetes complications.

RESULTS—In group 2, UFC (125.2 ± 4.6 nmol/24 h) and F24 (120.6 ± 4.1 nmol/l) were higher than in group 1 (109.2 ± 6.8 nmol/24 h, P = 0.057, and 99.7 ± 6.1 nmol/l, P = 0.005, respectively) and in nondiabetic patients (101.7 ± 5.9 nmol/24 h, P = 0.002, and 100.3 ± 5.3 nmol/l, P = 0.003, respectively). In diabetic patients, the number of complications was associated with F24 (R = 0.345; P < 0.0001) and diabetes duration (R = 0.39; P < 0.0001). Logistic regression analysis showed that the presence of diabetes complications was significantly associated with F24, sex, duration of diabetes, and glycated hemoglobin.

CONCLUSIONS—In type 2 diabetic subjects, hypothalmic-pituitary-adrenal activity is enhanced in patients with diabetes complications and the degree of cortisol secretion is related to the presence and number of diabetes complications.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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    • Accepted October 10, 2006.
    • Received June 19, 2006.
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