Podsumowanie

Kortyzol odgrywa istotną rolę w regulacji gospodarki węglowodanowej, a jego przewlekły nadmiar może być jedną z przyczyn pogorszenia wyrównania metabolicznego. W codziennej praktyce diabetologicznej zaburzenia wydzielania kortyzolu należy brać pod uwagę przede wszystkim u chorych z cukrzycą trudną do wyrównania, zwłaszcza jeśli współistnieją cechy kliniczne i choroby towarzyszące hiperkortyzolemii. Szczególnej czujności wymagają również pacjenci z incydentaloma nadnercza i łagodną autonomiczną hipersekrecją kortyzolu. Jednocześnie ocena stresu cukrzycowego, depresji, lęku i innych problemów psychologicznych powinna stanowić stały element opieki, ponieważ czynniki te wpływają na compliance, samokontrolę i skuteczność leczenia.

ABSTRACT

Chronic stress, cortisol and regulation of diabetes: The clinical importance and diagnosis of hypothalamic-pituitary-adrenal axis disorders

Cortisol is the main glucocorticoid involved in the stress response and an important counterregulatory hormone to insulin. Chronic activation of the hypothalamic-pituitary-adrenal axis and sustained cortisol excess may impair glucose homeostasis by increasing hepatic gluconeogenesis, promoting insulin resistance, and adversely affecting beta-cell function. This article discusses the role of cortisol in the regulation of carbohydrate metabolism and the clinical relevance of chronic stress in patients with prediabetes and diabetes. Particular attention is given to the diagnostic assessment of cortisol secretion, including the interpretation of serum, salivary, urinary, and dexamethasone suppression testing, as well as to the differential diagnosis of hypercortisolism, including Cushing syndrome, mild autonomous cortisol secretion, and functional hypercortisolism. The paper also summarizes clinical data linking altered cortisol secretion with fasting glucose, HbA1c, beta-cell dysfunction, and disturbed circadian cortisol patterns in type 2 diabetes. It also highlights the role of diabetes distress and chronic psychosocial stress as factors that may worsen metabolic control. From a practical perspective, the assessment of stress burden and psychological well-being should be considered an integral part of diabetes care, particularly in patients with poor glycemic control or features suggesting cortisol excess.

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