Response to De Koster and al. Thuillier P, Benisvy D, Ansquer C, Corvilain B, Mirallie E, Taieb D, et al.: What is the role of functional imaging and isotopic treatment? Ann Endocrinol (Paris) 2022. https://doi.org/10.1016/j.ando.2022.10.008.

Although there is a close relationship between cortisol and growth hormone (GH) levels, glucose intolerance and hepatosteatosis, changes in GH and the hypothalamo-pituitary-adrenal (HPA) axis were not previously studied in prediabetes. The main purpose of the present study was to assess changes in GH and HPA axis and their relationship with hepatosteatosis in prediabetic patients.Forty prediabetic patients, with body-mass index (BMI) 25–35 kg/m2, and 23 healthy individuals, with normal glucose tolerance and similar age and BMI, were included. The 75 g oral glucose tolerance test and glucagon stimulation test (GST) were used.No significant differences were detected between prediabetic patients and healthy individuals in terms of insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein-3 (IGFBP-3), IGF-1/IGFBP3 ratio or adrenocorticotropic hormone (ACTH). GH responses to GST did not differ between groups. On the other hand, peak cortisol and area under the curve (AUC) (cortisol) response on GST were significantly lower in prediabetic patients. Both peak GH and AUC (GH) response on GST correlated negatively with waist circumference and body weight. The degree of hepatosteatosis correlated negatively with peak cortisol, GH, AUC (cortisol) and AUC (GH) response on GST.Cortisol response to GST is decreased in prediabetic patients, with relatively well conserved GH response. This suggests altered HPA axis responsiveness in prediabetes, as is known in diabetes. Thus, HPA axis changes in patients with diabetes probably start before the development of diabetes as such.