DIAGNOSTIC VALUE OF CORTISOL IN PATIENTS WITH DIABETES MELLITUS

Abstract

Introduction. Diabetes mellitus is a pandemic affecting millions of people all over the world. One of the links in the pathogenesis of diabetes is the activation of the hypothalamic-pituitary-adrenal (HGN) system. Cortisol plays an important role in maintaining energy levels and metabolic processes, but its long-term secretion leads to negative consequences. Cortisol activates glucocorticoid receptors, which triggers a negative feedback mechanism, suppressing further ACTH secretion. However, under chronic stress, this system can become disrupted, resulting in persistently elevated cortisol levels. Such dysregulation can cause metabolic changes, including the development of metabolic syndrome (MS) and obesity, which is often the background for DM. A high level of cortisol affects the accumulation of fat, especially in the abdominal region, increased insulin resistance, arterial hypertension, and dyslipidemia, which are the main components of MS.

The aim of the study – to assess the cortisol content in the peripheral blood of patients with diabetes depending on the level of glycemia.

Research Methods. Peripheral blood of patients with diabetes aged 45 to 75 years (average age – (55±5) years) was studied. The control group consisted of 20 practically healthy patients. The 1st group included 20 patients with diabetes whose glucose level did not exceed the renal threshold (<8.0 mmol/l) and 20 patients with diabetes whose glucose level exceeded the renal threshold (>8.0 mmol/l). Cortisol was determined by enzyme-linked immunosorbent assay (ELISA) using the “DS-ELISA-Steroid-Cortisol” reagent kit using monoclonal antibodies.

Results and Discussion. Cortisol content in blood serum of patients of the 1st group ((198.47±0.47) ng/ml) was 1.3 times higher than the indicator of the control group ((157.68±0.12) ng/ml, p<0.05). Its average concentration in the blood serum of patients of the 2nd group was (296.68±0.48) ng/ml, which is 1.9 times higher than the control value and exceeded the indicator of the 1st group by 1.4 times (p<0.05).

Conclusions. The change in cortisol concentration confirms the pathogenetic significance in the development of diabetes. In particular, a high level of cortisol is associated with central obesity, one of the main components of the development of diabetes. Excess cortisol inhibits the translocation of GLUT4 glucose transporters to the plasma membrane of cells in response to insulin, which limits glucose uptake by tissues. This leads to a decrease in sensitivity to insulin and an increase in the level of glucose in the blood. Determination of cortisol can be used as a marker of metabolic disorders.