Adrenocortical insufficiency and diabetes mellitus type 1

: Adrenocortical disorders represents an important problem in patients with type 1 diabetes mellitus and therefore many physicians are concerned with this issue. The causes of adrenocortical insufficiency include both autoimmunity and dysregulation related to insufficiently compensated diabetes. Early diagnosis of hypocorticism remains doubtful. Diagnostic approaches are not standardized or unified and especially their evaluation and interpretation are a matter of discussion. Treatment of proven hypocorticism, notably of the subclinical form in diabetic patients, remains questionable. Modes of substitution used presently cannot mimic fully diurnal rhythm of glucocorticoid secretion in spite of newly developed drug forms. The risk of glucocorticoid overdose persists, and insulinotherapy need to be adjusted permanently.