Effect of very low LDL-cholesterol on cortisol synthesis

Sezer, Kerem; Emral, Rıfat; Çorapçıoğlu, Demet; Gen, Ramazan; Akbay, Esen

doi:10.1007/bf03345655

Cited by 10 publications

(8 citation statements)

References 33 publications

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“…Cholesterol forms the basic structure of many hormones (e.g. cortisol, aldosterone) (1). Of interest, this patient had a relatively low total cholesterol and LDL cholesterol.…”

Section: Discussionmentioning

confidence: 85%

Adrenal insufficiency following bariatric surgery

et al. 2012

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A 35-year-old woman with morbid obesity and amenorrhoea underwent a bilo-pancreatic diversion (BPD). Surgery was successful with good weight loss, restoration of menstruation and almost immediately she conceived for the first time. She was commenced on routine vitamin supplements after surgery but failed to attend follow-up clinic. Five years later, she presented with limb girdle pains, lethargy, night blindness, skin pigmentation, amenorrhoea and dizziness. She had stopped taking supplements prescribed after the surgery. Investigations showed severe vitamin A and D deficiency along with iron and calcium deficiency. Her cholesterol was low at 3.5 mmol L⁻¹. Despite aggressive vitamin replacement, she continued to complain of lethargy and dizziness. Subsequently, three short adrenocorticotropic hormone-stimulation tests were suboptimal (basal cortisol: 196, 185 and 223 nmol L⁻¹; 30 min cortisol: 421, 453 and 435 nmol L⁻¹). She was subsequently commenced on adrenal replacement and her symptoms resolved and she conceived. We describe for the first time in the literature the unexpected finding of adrenal insufficiency following a BPD.

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“…Cholesterol forms the basic structure of many hormones (e.g. cortisol, aldosterone) (1). Of interest, this patient had a relatively low total cholesterol and LDL cholesterol.…”

Section: Discussionmentioning

confidence: 85%

Adrenal insufficiency following bariatric surgery

et al. 2012

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“…Specifically, concern has been raised regarding the impact of lowering LDL‐C and TC on hormonal synthesis and neural development. However, several studies have not shown impact on either adrenal or testicular steroidogenesis with pharmacologic lowering of LDL‐C to levels <70 mg/dL, 15,16 and statin therapy has been associated with a reduced incidence of dementia 17 . Finally, there is concern of an increased incidence of cancer with lipid‐lowering therapy.…”

Section: Discussionmentioning

confidence: 99%

LDL = 5: Virtues and Dangers of Multidrug Therapy of Low-Density Lipoprotein Cholesterol

Phillips

Schaefer

2010

Preventive Cardiology

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“…27,31 In another study of patients selected on the basis of LDL-C <1.8 mmol/L (70 mg/dL), with a mean LDL-C of 1.5 mmol/L (58 mg/dL), adrenal function was also normal. 50 In our study, we observed no evidence of hypoadrenalism (decreased cortisol, increased ACTH, or a decreased cortisol:ACTH ratio) in evolocumab-treated patients, even in those achieving very low LDL-C. The statistically significant increase in cortisol among evolocumab-treated patients was an unexpected finding but is likely not of clinical significance given the small absolute increase from a mean of 377.2±156.73 nmol/L at baseline to 404.1±146.89 nmol/L at week 52.…”

Section: 22mentioning

confidence: 99%

Effects of Evolocumab on Vitamin E and Steroid Hormone Levels

Blom

Djedjos

Monsalvo

et al. 2015

Circulation Research

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Rationale : Vitamin E transport and steroidogenesis are closely associated with low-density lipoproteins (LDLs) metabolism, and evolocumab can lower LDL cholesterol (LDL-C) to low levels. Objective: To determine the effects of evolocumab on vitamin E and steroid hormone levels. Methods and Results: After titration of background lipid-lowering therapy per cardiovascular risk, 901 patients with an LDL-C ≥2.0 mmol/L were randomized to 52 weeks of monthly, subcutaneous evolocumab, or placebo. Vitamin E, cortisol, adrenocorticotropic hormone, and gonadal hormones were analyzed at baseline and week 52. In a substudy (n=100), vitamin E levels were also measured in serum, LDL, high-density lipoprotein, and red blood cell membranes at baseline and week 52. Absolute vitamin E decreased in evolocumab-treated patients from baseline to week 52 by 16% but increased by 19% when normalized for cholesterol. In the substudy, vitamin E level changes from baseline to week 52 mirrored the changes in the lipid fraction, and red blood cell membrane vitamin E levels did not change. Cortisol in evolocumab-treated patients increased slightly from baseline to week 52, but adrenocorticotropic hormone and the cortisol:adrenocorticotropic hormone ratio did not change. No patient had a cortisol:adrenocorticotropic hormone ratio <3.0 (nmol/pmol). Among evolocumab-treated patients, gonadal hormones did not change from baseline to week 52. Vitamin E and steroid changes were consistent across subgroups by minimum postbaseline LDL-C <0.4 and <0.6 mmol/L. Conclusions: As expected, vitamin E levels changed similarly to lipids among patients treated for 52 weeks with evolocumab. No adverse effects were observed in steroid or gonadal hormones, even at very low LDL-C levels. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01516879.

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Effect of very low LDL-cholesterol on cortisol synthesis

Abstract: Our data reflect that having serum LDL-cholesterol levels below 70 mg/dl did not affect the adrenal axis function in terms of cortisol.

Cited by 10 publications

References 33 publications

Adrenal insufficiency following bariatric surgery

Adrenal insufficiency following bariatric surgery

LDL = 5: Virtues and Dangers of Multidrug Therapy of Low-Density Lipoprotein Cholesterol

Effects of Evolocumab on Vitamin E and Steroid Hormone Levels

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