Publication Name	World Journal of Diabetes
Manuscript ID	124386
DOI	10.4239/wjd.124386
Country	Greece

Category	Endocrinology & Metabolism
Manuscript Type	Correspondence
Article Title	Letter to the Editor: Hypothalamic-pituitary-adrenal axis dysregulation as a plausible contributor to glycated hemoglobin variability and cardiovascular risk in diabetes mellitus
Manuscript Source	Unsolicited Manuscript
All Author List	Ioannis Ilias and Lina Zabuliene
Funding Agency and Grant Number
Corresponding Author	Ioannis Ilias, Director, MD, PhD, Department of Endocrinology, Hippocration General Hospital, No. 63 Evrou Street, Athens GR-11521, Greece. iiliasmd@yahoo.com
Key Words	Glycated hemoglobin; HbA1c variability; Hypothalamic-pituitary-adrenal axis; Cortisol; Cardiovascular risk; Diabetes mellitus; Adrenal incidentaloma
Core Tip	The inter-visit variability of glycated hemoglobin (HbA1c) independently predicts cardiovascular outcomes in diabetes mellitus, yet its mechanistic determinants remain incompletely characterized. We propose that hypothalamic–pituitary–adrenal (HPA) axis dysregulation is a plausible, underrecognized contributor, operating through two tiers. One tier involves sustained cortisol excess-as seen in mild autonomous cortisol secretion from adrenal incidentalomas or in subclinical Cushing’s syndrome, which shifts mean HbA1c measurably across consecutive visits. The second tier involves hyperglycemia-driven HPA hyperactivity, mediated by pro-inflammatory cytokines, which perpetuates a feed-forward glycemic loop. Unexplained inter-visit HbA1c variability, after exclusion of common causes, may warrant targeted HPA axis evaluation in selected patients.
Citation	Ilias I, Zabuliene L. Letter to the Editor: Hypothalamic-pituitary-adrenal axis dysregulation as a plausible contributor to glycated hemoglobin variability and cardiovascular risk in diabetes mellitus. World J Diabetes 2026; In press DOI: https://doi.org/10.4239/wjd.124386
PDF	124386-in-press.pdf

Received	2026-06-15 01:28
Peer-Review Started	2026-06-16 00:06
First Decision by Editorial Office Director
Return for Revision	2026-07-03 09:34
Revised	2026-07-06 16:10
Publication Fee Transferred
Second Decision by Editor	2026-07-17 02:38
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-07-17 08:24
Articles in Press	2026-07-17 08:24
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9358 (online)
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Copyright	©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
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