Adrenal Cortical Activity in Diabetes Mellitus

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In order to obtain some informations about adrenal cortical activity in diabetics, I have observed the changes of glucocorticoids activity measured by urinary excretion of total 17-hydroxycorticosteroids (17-OHCS) in the course of the treatment of diabetics. Following results were obtained.1. Of 22 uncontrolled diabetics, not associated with diabetic ketosis and coma, 5 patients showed normal excretion of urinary 17-OHCS and 17 patients showed increased excretion of urinary 17-OHCS.2. Urinary 17-OHCS excretion was intimately correlated to the severity of diabetes.3. When diabetic states were controlled by insulin in 14 patients, 10 patients showed normal excretion of urinary 17-OHCS and 4 patients showed slightly increased excretion of urinary 17-OHCS. But urinary excretion of 17-OHCS in controlled state was lower than it before treatment in each case.4. By sulfonylurea therapy urinary excretion of 17-OHCS did not show decreasing tendency when diabetic states were well controlled.5. In the patients with cardiovascular complications, urinary excretion of 17-OHCS was lower than it of the patients without complications. This seemed to be attributable to the some severe patients who were found in uncomplicated patients.6. A patient with hyperthyroidism and 3 patients with acromegaly were all severe diabetic patients and showed highly increased excretion of urinary 17-OHCS before treatment. But urinary excretion of 17-OHCS decreased remarkably when the former treated by insulin and antithyroidal drug and the latter by insulin.7. 3 patients with diabetic ketosis and 3 with diabetic coma, those were considered to be the most severe state of diabetes, showed the most increased excretion of urinary 17-OHCS in all cases. Nevertheless, they decreased after recovery by insulin therapy.From these findings it may be concluded that adrenal cortical hyperactivity in diabetic patients is a derangement secondarily to the metabolic disturbances of diabetes mellitus, and insulin therapy is preferable to sulfonylurea therapy. No significant differences are found in adrenal cortical activity between the patients with cardiovascular complications and the patients without complications. But it is suspected that hyperadrenocorticism, when it persisted in long period, may play an important role on the pathogenesis of the cardiovascular complications.