cosyntropin and Diabetes-Mellitus--Type-1

Topics: Adolescent; Adrenal Insufficiency; Child; Cosyntropin; Diabetes Mellitus, Type 1; Dose-Response Relationship, Drug; Female; Hormones; Humans; Hydrocortisone; Male

Idiopathic Addison's disease occurs frequently in association with other organ-specific autoimmune diseases, and autoantibodies to adrenal cortex are markers of this condition. A variable asymptomatic period with subtle adrenal dysfunction may precede the onset of clinical manifestations. We studied the pituitary-adrenal axis by measuring plasma ACTH, cortisol, and 17 alpha-hydroxyprogesterone after ovine CRH (100 micrograms as an iv bolus) stimulation in 19 patients with organ-specific autoimmune disease and adrenal autoantibodies, in whom adrenal steroids were normal under baseline conditions and normally responsive to a standard ACTH stimulation test (250 micrograms). In all subjects, oCRH produced a normal increase in plasma ACTH. Plasma cortisol, which was normoresponsive in 11 subjects, showed little or no increase in 8 subjects. Two of these patients developed overt adrenal failure after 1 yr. The 17 alpha-hydroxyprogesterone response to oCRH, tested in 10 of 19 patients, paralleled that of plasma cortisol, excluding a steroidogenic block at the 21-hydroxylase site. Our data demonstrate the existence of a very early phase of Addison's disease in which adrenal function shows an impaired response to ovine CRH-stimulated ACTH.

Topics: 17-alpha-Hydroxyprogesterone; Addison Disease; Adrenal Glands; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aldosterone; Autoantibodies; Autoimmune Diseases; Corticotropin-Releasing Hormone; Cosyntropin; Diabetes Mellitus, Type 1; Female; Humans; Hydrocortisone; Hydroxyprogesterones; Hypothyroidism; Kinetics; Middle Aged; Thyroiditis, Autoimmune

The cortisol secretion rate was determined in 18 children according to a modified and simplified method. In 7 cases the determination was repeated after stimulation with synthetic ACTH. 12 of these children suffered from diseases which may affect glucocorticoidsteroid production and the remaining 6 children served as normal controls. In some cases the plasma 11-hydrocorticoid level and urinary excretion of 17-ketogenic steroids were additionally determined. Differences in adrenal function were noted in 2 patients with congenital adrenal hyperplasia (one of the salt-losing type, the other nonsalt-losing type) and 5 patients with adrenal insufficiency. A normal cortisol secretion rate was found in 3 children with diverse disturbances of carbohydrate metabolism, as well as in a child with subtotal adrenalectomy. The clinical value of the determination of the cortisol secretion rate is discussed and was found to be a more reliable indicator of glucocorticoid activity than other parameters.

Topics: 11-Hydroxycorticosteroids; 17-Ketosteroids; Adolescent; Adrenal Cortex; Adrenal Cortex Function Tests; Adrenal Insufficiency; Adrenalectomy; Adult; Child; Cosyntropin; Diabetes Mellitus, Type 1; Female; Humans; Hydrocortisone; Secretory Rate; Stimulation, Chemical