SAT-162 Potential Diagnostic Use of a Steroid Profile in Patients with Poorly Controlled Diabetes Mellitus

Cushing’s syndrome may contribute to insulin resistance and impaired insulin secretion in patients with diabetes mellitus. The prevalence of Cushing’s syndrome in human patients with type II diabetes mellitus has been reported as high as 9.4% (1), and prevalence of diabetes mellitus as a complication of Cushing’s syndrome has been reported as high as 50% (2). In our laboratory, evaluation of steroid profiles (analysis of cortisol, progesterone, 17-hydroxyprogesterone, androstenedione, estradiol, testosterone, and aldosterone at baseline and post-ACTH) in 3,600 dogs over 2 years revealed 2% to 8% of dogs with diabetes mellitus had concurrent hyperadrenocorticism. These steroid profiles in dogs with uncontrolled diabetes mellitus, despite insulin therapy, implicated elevated estradiol, progesterone, and 17-hydroxyprogesterone concentrations, with or without elevated cortisol, as probable contributors to poor control of glycemia. It has been reported that high doses of estradiol can decrease expression of insulin receptors in target tissues (3) and progesterone can decrease GLUT 4 expression in target tissues and modulate beta cell proliferation in the pancreas (4), thereby contributing to insulin resistance and possibly insulin secretion. In human patients, decreasing cortisol concentration in Cushing’s syndrome improves the glycemic state in many, but not all gain normoglycemia (5). It is suspected, that for some human patients, cortisol is not the only steroid involved in hyperglycemia and a steroid profile may be a useful diagnostic tool for investigating other steroids contributing to insulin resistance. References: (1) Nieman, Endocrinol Metab Clin N Am. 2018; 47:259-273. (2) Giordano et al., Eur J Endocrinol. 2014; 170:311-319. (3) Gonzalez et al., Steroids. 2002; 67:993-1005. (4) Branisteanu et al., TRENDS Endocrinol Metab. 2003; 14:54-56. (5) Rogowicz-Frontczak et al., Endokrynol Pol. 2017; 68:334-342.