Effects of cortisol on carbohydrate, lipid, and protein metabolism: studies of acute cortisol withdrawal in adrenocortical failure.
BACKGROUND
Cortisol is an important catabolic hormone, but little is known about the metabolic effects of acute cortisol deficiency.


OBJECTIVE
The objective of the study was to test whether clinical symptoms of weight loss, fatigue, and hypoglycemia could be explained by altered energy expenditure, protein metabolism, and insulin sensitivity during cortisol withdrawal in adrenocortical failure.


METHODS
We studied seven women after 24-h cortisol withdrawal and during replacement control during a 3-h basal period and a 3-h glucose clamp.


RESULTS
Cortisol withdrawal generated cortisol levels close to zero, a 10% decrease in basal energy expenditure, increased TSH and T(3) levels, and increased glucose oxidation. Whole-body glucose and phenylalanine turnover were unaltered, but forearm phenylalanine turnover was increased. During the clamp glucose, infusion rates rose by 70%, glucose oxidation rates increased, and endogenous glucose production decreased. Urinary urea excretion decreased by 40% over the 6-h study period.


CONCLUSIONS
Cortisol withdrawal increased insulin sensitivity in terms of increased glucose oxidation and decreased endogenous glucose production; this may induce hypoglycemia in adrenocortical failure. Energy expenditure and urea loss decreased, indicating that weight and muscle loss in Addison's disease is caused by other mechanisms, such as decreased appetite. Increased muscle protein breakdown may amplify the loss of muscle protein.
Christiansen
Jens Juel
JJ
Medical Department M, Aarhus Sygehus NBG, Arhus University Hospital, DK-8000 C Arhus, Denmark. juel@dadlnet.dk
Djurhuus
Christian B
CB
Gravholt
Claus H
CH
Iversen
Per
P
Christiansen
Jens Sandahl
JS
Schmitz
Ole
O
Weeke
Jørgen
J
Jørgensen
Jens Otto Lunde
JO
Møller
Niels
N
D000208:Acute Disease; D000224:Addison Disease / Q000097:blood / Q000188:drug therapy / Q000378:metabolism; D000307:Adrenal Gland Diseases / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism*; D000328:Adult; D001481:Basal Metabolism / Q000187:drug effects; D002153:Calorimetry, Indirect; D050260:Carbohydrate Metabolism / Q000187:drug effects*; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000172:deficiency* / Q000494:pharmacology* / Q000627:therapeutic use*; D050356:Lipid Metabolism / Q000187:drug effects*; D017551:Microdialysis; D008875:Middle Aged; D011506:Proteins / Q000378:metabolism*; D028761:Withholding Treatment
D011506:Proteins; D005947:Glucose; D006854:Hydrocortisone