title: Investigation of glucocorticoid receptor polymorphisms in relation to metabolic parameters in Addison's disease.
abstract: BACKGROUND
  Uncertainty exists whether glucocorticoid receptor (GCR) polymorphisms play a role in steroid-related side effects in Addison's disease (AD) patients on hydrocortisone. The polymorphisms Bcll and N363S appear to increase sensitivity to cortisol, while the ER22/23EK polymorphism has been associated with resistance to cortisol.
  
  
  METHODS
  One hundred and forty seven AD patients, and gender, and ethnicity-matched controls were recruited in South Africa. Three polymorphisms in the GCR were studied, using PCR followed by restriction fragment length analysis. Associations with BMI, lipids, glucose and inflammatory markers were investigated.
  
  
  RESULTS
  In both patients and controls, the Bcll polymorphism occurred more frequently in whites than in other ethnic groups studied but was not associated with any of the metabolic parameters tested. The ER22/23EK polymorphism was associated with an increased BMI in both patients (29.4 vs 24.7  kg/m²) and control subjects (26.3 vs 24.2  kg/m²). The ER22/23EK polymorphism was also associated with lower LDL cholesterol in control subjects (3.46 vs 3.93  mmol/l) and in patients (3.52 vs 4.10  mmol/l). N363S was associated with increased BMI in controls 29.9  kg/m² vs wild type 24.8  kg/m². Median hydrocortisone doses were greater in patients heterozygous for either ER22/23EK 30.0  mg or N363S 25.0  mg polymorphisms than in wild type patients 20.0  mg (both comparisons).
  
  
  CONCLUSIONS
  Alterations in lipids, BMI and hydrocortisone dose were associated with two polymorphisms. Further larger studies are warranted to corroborate these findings.
authors.affiliation: Division of Endocrinology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, J47 Old Main Building, Cape Town 7925, South Africa. ian.ross@uct.ac.za
authors.forename: I L
authors.initials: IL
authors.lastname: Ross
authors.forename: N S
authors.initials: NS
authors.lastname: Levitt
authors.forename: L
authors.initials: L
authors.lastname: Van der Merwe
authors.forename: D A
authors.initials: DA
authors.lastname: Schatz
authors.forename: G
authors.initials: G
authors.lastname: Johannsson
authors.forename: C
authors.initials: C
authors.lastname: Dandara
authors.forename: T S
authors.initials: TS
authors.lastname: Pillay
authors.forename: D J
authors.initials: DJ
authors.lastname: Blom
mesh_terms: D000224:Addison Disease / Q000150:complications / Q000188:drug therapy / Q000235:genetics* / Q000503:physiopathology*; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D005260:Female; D056726:Genetic Association Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications*; D011110:Polymorphism, Genetic; D011965:Receptors, Glucocorticoid / Q000235:genetics* / Q000378:metabolism; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids; C497713:NR3C1 protein, human; D011965:Receptors, Glucocorticoid; D006854:Hydrocortisone