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Adrenal medullary fibrosis in IDDM of long duration
F M Brown1, M Zuckerman, S Longway
1Immunology Section, Joslin Diabetes Center, Boston, MA 02215.
Abstract:
We conducted a retrospective pathology study to determine whether subjects with long-standing insulin-dependent diabetes mellitus (IDDM) have abnormalities of the adrenal medulla compared with subjects with non-insulin-dependent diabetes mellitus (NIDDM) and nondiabetic individuals. Slides were scored from 0 (no fibrosis) to 3+ (complete fibrosis). Nineteen IDDM subjects aged 30-60 yr (mean +/- SE 44.9 +/- 2.5 yr) at autopsy and with duration of diabetes 13-45 yr (26.8 +/- 1.8 yr) were studied. Twelve NIDDM subjects aged 61-84 yr (73.3 +/- 2.5 yr) with duration of diabetes 17-33 yr (22.8 +/- 1.9 yr) were studied. Twenty-two nondiabetic subjects aged 32-77 yr (53.7 +/- 2.9 yr) were studied. Four of 19 (27%) IDDM subjects had moderate to severe fibrosis compared to 1 of 12 (8.3%) NIDDM subjects and 1 of 22 (4.5%) control subjects. Thirteen of 19 (68%) IDDM subjects had a score of 1, 2, or 3 compared to 3 of 22 (13.6%) control subjects (P less than .0005). There was an association between duration of IDDM and fibrosis score (r = .46, P less than .05) and between age and fibrosis score among IDDM subjects (r = .57, P = .01). No association between age or duration of diabetes and fibrosis score was observed for NIDDM or control subjects. Adrenal medullary fibrosis may be an anatomical correlate of the diminished epinephrine secretion that occurs in response to insulin-induced hypoglycemia in some IDDM subjects.
Insights
Long-standing insulin-dependent diabetes mellitus (IDDM) is associated with adrenal medullary fibrosis. This adrenal abnormality may explain reduced epinephrine secretion in response to hypoglycemia in some IDDM patients.
Area of Science:
- Endocrinology
- Pathology
- Diabetology
Background:
- Insulin-dependent diabetes mellitus (IDDM) can lead to complications affecting various organs.
- The adrenal medulla plays a crucial role in glucose homeostasis and stress response.
- Previous studies have suggested potential links between diabetes and adrenal gland abnormalities.
Purpose of the Study:
- To investigate adrenal medullary abnormalities in individuals with long-standing IDDM.
- To compare the prevalence of adrenal medullary fibrosis in IDDM, non-insulin-dependent diabetes mellitus (NIDDM), and nondiabetic individuals.
Main Methods:
- Retrospective pathology study analyzing adrenal medulla slides.
- Fibrosis scoring from 0 (no fibrosis) to 3+ (complete fibrosis).
- Comparison of fibrosis scores among 19 IDDM, 12 NIDDM, and 22 nondiabetic subjects.
Main Results:
- 27% of IDDM subjects exhibited moderate to severe adrenal medullary fibrosis, compared to 8.3% of NIDDM and 4.5% of controls.
- 68% of IDDM subjects had any degree of fibrosis (score 1-3), versus 13.6% of controls (P < .0005).
- A significant association was found between the duration of IDDM and fibrosis score (r = .46, P < .05), and between age and fibrosis score in IDDM subjects (r = .57, P = .01).
Conclusions:
- Long-standing IDDM is associated with a higher prevalence of adrenal medullary fibrosis.
- Adrenal medullary fibrosis may be an anatomical correlate of diminished epinephrine secretion observed in some IDDM patients during hypoglycemia.
- These findings highlight a potential pathological link between diabetes duration and adrenal medulla structure.