Effects of Cortisol on Carbohydrate, Lipid, and Protein Metabolism: Studies of Acute Cortisol Withdrawal in Adrenocortical Failure

Christiansen, Jens Juel; Djurhuus, Christian; Gravholt, Claus Højbjerg; Iversen, Per Ole; Christiansen, Jens Sandahl; Schmitz, Ole; Weeke, Jørgen; Jørgensen, Jens Otto Lunde; Møller, Niels

doi:10.1210/jc.2007-0445

Cited by 140 publications

(101 citation statements)

References 35 publications

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“…The study by Christiansen et al demonstrated that acute withdrawal of cortisol increased insulin sensitivity close to 70%, increased glucose oxidation by 50%, with decreased endogenous glucose production, implying that adrenocortical failure could result in hypoglycemia (111). Meyer et al studied 13 patients with primary adrenal insufficiency using continuous glucose monitoring for 3-5 days (112).…”

Section: Hypoglycemia In Adrenal Insufficiencymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

Kittah

Vella

2017

European Journal of Endocrinology

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Glucose is the main substrate utilized by the brain and as such multiple regulatory mechanisms exist to maintain glucose concentrations. When these mechanisms fail or are defective, hypoglycemia ensues. Due to these robust mechanisms, hypoglycemia is uncommon and usually occurs in the setting of the treatment of diabetes using glucose-lowering agents such as sulfonylureas or insulin. The symptoms of hypoglycemia are non-specific and as such it is important to confirm hypoglycemia by establishing the presence of Whipple's triad before embarking on an evaluation for hypoglycemia. When possible, evaluation of hypoglycemia should be carried out at the time of spontaneous occurrence of symptoms. If this is not possible then one would want to create the circumstances under which symptoms occur. In cases where symptoms occur in the post absorptive state, a 72-h fast should be performed. Likewise, if symptoms occur after a meal then a mixed meal study may be the test of choice. The causes of endogenous hyperinsulinemic hypoglycemia include insulinoma, post-bariatric hypoglycemia and noninsulinoma pancreatogenous hypoglycemia syndrome. Autoimmune hypoglycemia syndrome is clinically and biochemically similar to insulinoma but associated with high levels of insulin antibodies and plasma insulin. Other important causes of hypoglycemia include medications, non-islet cell tumors, hormonal deficiencies, critical illness and factitious hypoglycemia. We provide an overview of the pathogenesis and management of hypoglycemia in these situations.

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Section: Hypoglycemia In Adrenal Insufficiencymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

Kittah

Vella

2017

European Journal of Endocrinology

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“…*In AI, insulin sensitivity is enhanced because of cortisol deficiency [11], and an excessive hypoglycemic reaction is often introduced by ITT. Usually, intravenous injection of rapid-acting insulin at a dose of 0.1 U/kg body weight (BW) is recommended.…”

Section: I-26mentioning

confidence: 99%

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

et al. 2016

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Abstract. This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 µg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test. Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 µg/ dL in the insulin tolerance test indicates normal adrenal function. In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI. In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary. From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis. In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used. Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis.Key words: Adrenal insufficiency, Adrenal crisis, Cortisol, Hydrocortisone, Congenital adrenal hyperplasia Summary of Recommendations I. Chronic adrenal insufficiency (AI) I-1.0 SymptomsWe recommend suspecting AI in patients who have the following symptoms.

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“…In contrast to the anabolic properties of DHEA and DHEAS, cortisol (when in excess) has catabolic properties [138]. Cortisol mobilises glucose, free fatty acids and amino acids from endogenous stores [138].…”

Section: Copd and Adrenal Axismentioning

confidence: 99%

Endocrinological derangements in COPD

Laghi

Adıgüzel²,

Tobin³

2009

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders, such as those involving the pituitary, the thyroid, the gonads, the adrenals and the pancreas.The mechanisms by which COPD alters endocrine function are incompletely understood but likely involve hypoxaemia, hypercapnia, systemic inflammation and glucocorticoid administration. Altered endocrine function can worsen the clinical manifestations of COPD through several mechanisms, including decreased protein anabolism, increased protein catabolism, nonenzymatic glycosylation and activation of the rennin-angiotensin-aldosterone system.Systemic effects of endocrine disorders include abnormalities in control of breathing, decreases in respiratory and limb-muscle mass and function, worsening of respiratory mechanics, impairment of cardiac function and disorders of fluid balance.Research on endocrine manifestations of COPD embraces techniques of molecular biology, integrative physiology and controlled clinical trials. A sound understanding of the various disorders of endocrine function associated with COPD is prudent for every physician who practices pulmonary medicine.

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Effects of Cortisol on Carbohydrate, Lipid, and Protein Metabolism: Studies of Acute Cortisol Withdrawal in Adrenocortical Failure

Cited by 140 publications

References 35 publications

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

Endocrinological derangements in COPD

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