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This diabetes-induced subclinical hypercortisolism is thought to result from decreased hippocampal regulation of the HPA axis due to hyperglycemia-induced atrophy within this region (290)

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Mechanical or inflammatory injury to the hypothalamus alters neuroendocrine secretion and contributes to systemic insulin resistance induced by inflammation/hyperglycemia, further impairing metabolic regulation and glucose uptake [60]