Dissociation of Adrenarche and Gonadarche in Diabetes Mellitus

Abstract

Serum concentrations of testosterone and dehydroepiandrosterone sulphate (DHAS) have been measured in 10 stable insulin-dependent diabetic (IDD) males (chronological age (CA) range 13.0-17.5 years). Their results have been compared with those of a control population of 69 non-diabetic males who presented with mild constitutional growth delay and whose skeletal maturity and pubertal development were similar to the diabetic subjects. Within bone ages (BA) 11.0-14.5 years no significant difference was observed between the serum testosterone concentrations of the diabetic patients and controls: diabetic males, 8.2 (0.3-25) nmol/l (median and range); controls, 7.0 (less than 0.3-23) nmol/l. In contrast, within BA 11.0-14.5 years, the diabetic males had significantly lower serum DHAS concentrations: diabetic males, 1.1 (0.7-4.2) mumol/l; controls, 3.7 (0.7-5.6) mumol/l (P less than 0.001). The serum DHAS concentrations of the diabetic males were also significantly lower than the controls when matched separately for pubic hair and genital development, testicular volume and serum testosterone, (in each comparison P less than 0.02). Serum DHAS concentrations of the diabetic males did not correlate significantly with CA, BA, BA delay (CA-BA), age of onset of diabetes, duration of diabetes, or glycosylated haemoglobin (GHb), but significant correlation was observed between BA delay and duration of diabetes, r = 0.65, P less than 0.05. We conclude that gonadarche appears to proceed despite delayed adrenarche in IDD males. This study presents further evidence in favour of adrenarche and gonadarche being independent physiological events. The causes and clinical significance of low serum DHAS concentrations in adolescent diabetic males remain to be established.

Depression of dehydroepiandrosterone in Japanese diabetic men—comparison between non-insulin-dependent diabetes mellitus and impaired glucose tolerance

“…We found a decrease in DHEA (r= -0.208, p<0.05) and DHEA-S (r = -0.353, < 0.001) with advancing age. However, a study by Cohen and co-workers found significantly lower DHEA-S concentrations in pubertal diabetic men compared to non-diabetic controls matched for bone age, although they were unable to show any correlation between the glycémie control and DHEA-S concentrations in diabetic subjects (15). Neither DHEA nor DHEA-S showed any correlation with BMI, PG, TC, HDL-C, TG or IRI.…”

Androgen Levels in Men with Diabetes Mellitus

“…'5 found raised serum androstenedione and DHEA levels in diabetic females but adolescent diabetic boys had low DHEAS levels when matched for bone age with non-diabetic boys who had presented with constitutional delayed puberty. 16 Low serum levels of adrenal androgens if found in adult men as reported in adolescent diabetic boys might then have a deleterious effect on islet cell activity. The finding of normal adrenal androgen levels in adult diabetic patients suggests that adrenal androgen status is unlikely to be an important influence on islet cell function in humans with diabetes mellitus.…”

The Role of Dehydroepiandrosterone in Diabetes Mellitus

“…Between the ages of 5 and 7 years, the adrenals once again begin synthesizing and secreting DHEA, heralding adrenarche. 13 Peak levels are reached by men at age 20-24 years. They occur somewhat earlier in women, between ages 15 and 19 years.…”

“…Abnormal physiologic conditions in which androgens are pathologically elevated are associated with insulin resistance. 13 Historically, hyperandrogenism was thought to be the cause of the insulin resistance. It is now believed that the converse is true, that hyperinsulinemia may cause hyperandrogenism.…”