Clinical significance of proadrenomedullin level in patients with type 2 diabetes and thyroid dysfunction

Diabetes mellitus and thyroid dysfunction are two of the most common endocrine disorders seen in the adult population and mutually influence each other. In particular, it was found that the combination of these pathologies worsens the course of type 2 diabetes mellitus (T2DM) and the progression of macro‑ and microvascular complications. An essential aspect of predicting the risk of complications in such patients is determining the level of vasodilator peptides, which have protective properties of the vascular wall. One such peptide is proadrenomedullin (pro‑ADM), which may be a marker of endothelial dysfunction and a potential predictor of vascular complications in patients with combined thyroid pathology and T2DM. The aim of the work is to analyze the relationship between the level of proadrenomedullin and indicators of the functional status of the thyroid gland in patients with T2DM and thyroid dysfunction. Materials and methods. 86 patients with T2DM and newly discovered thyroid dysfunction (hypothyroidism and hyperthyroidism), as well as patients with normal thyroid function (euthyroidism), were examined. The level of proadrenomedullin in blood serum was determined for all patients. Results. In the group of patients with hypothyroidism, women predominated (70%), and in the group with hyperthyroidism — men (60%). The highest level of pro‑ADM in the group of patients with hypothyroidism was 44.77±4.13 pmol/l. A statistically significant increase in this indicator was found in the group with hypothyroidism, compared to the group with euthyroidism (p<0.001) and the group with hyperthyroidism (p<0.05). The level of pro‑ADM in both groups of patients shows statistically significant correlations with the selected parameters. In the group with hypothyroidism, age was directly correlated in mean strength with the level of pro‑ADM (58.62±1.55 years) (R=0.363; p<0.05). A weak direct proportional relationship between the level of pro‑ADM and BMI (31.08±0.66 kg/m2) (R=0.095; p>0.05) was revealed. We calculated a weak direct correlation between the level of pro‑ADM and HbA1c (9.44±0.31%) (R=0.206; p<0.05). A weak negative correlation was established between the level of pro‑ADM and with TSH (6.26±0.49 mIU/ml) (R=–0.289; p<0.05). A weak positive relationship between the level of pro‑ADM and fT3 (1.01±0.81 pg/ml), (R=0.054; p<0.01) and fT4 (5.33±0.49 pmol/ml) was revealed), (R=0.102; p<0.01).In patients with hyperthyroidism, the level of pro‑ADM correlated with age in a direct weak force (55.67±2.31 years) (R=0.196; p<0.01). A weak but direct proportional relationship between the level of pro‑ADM and BMI (33.14±1.27 kg/m2) (R=0.137; p>0.05) was revealed. A solid direct correlation was calculated between the level of pro‑ADM and HbA1c (9.53±0.44%) (R=0.606; p<0.05). A weak positive correlation was established between the level of pro‑ADM and TSH (0.24±0.03 mIU/ml) (R=0.240; p<0.01). A weak negative relationship was found between the level of pro‑ADM and fT3 (4.59±0.63 pg/ml), (R=–0.016; p<0.01) and fT4 (26.43±2.88 pmol/ml), (R=–0.181; p<0.01). Conclusions. In patients with T2DM, a significant increase in pro‑ADM levels was found in the presence of hypothyroidism. This indicator showed a strong positive correlation with age, BMI, and HbA1c in both patient groups. A direct positive correlation between pro‑ADM and TSH, and an inverse correlation with fT3 and fT4 were also observed in the hypothyroidism group, while in the hyperthyroidism group, pro‑ADM correlated directly with TSH and positively with fT3 and fT4.