Reduced insulin sensitivity as a marker for acute mountain sickness?
Reduced insulin sensitivity might increase the susceptibility to acute mountain sickness (AMS). The diabetogenic side effects of dexamethasone should therefore be considered for AMS treatment. To examine whether reduced insulin sensitivity is predictive of AMS and how it is affected by dexamethasone at high altitude, we analyzed endocrine and metabolic parameters obtained from healthy mountaineers in Zurich (LA; 490 m), and 2 and 4 days after fast ascent to the Capanna Regina Margherita (HA2, HA4; 4559 m). 14 of 25 participants developed AMS and were treated with dexamethasone starting in the evening of HA2. Before and after ingestion of an 1800 kJ meal, plasma was analyzed for erythropoietin (EPO) and cholecystokinin (CCK). Insulin sensitivity (HOMA-S) and beta cell activity were calculated. HOMA-S (p<0.01) and EPO levels (p<0.05) were lower in Zurich in the group developing AMS and given dexamethasone, i.e., before treatment and exposure to hypoxia. CCK was lower (p<0.01) and glucose and insulin were higher on HA4 in the dexamethasone group compared to the untreated group. Individuals with low baseline insulin sensitivity and low baseline EPO levels were more susceptible to AMS. Reduced CCK may contribute to the beneficial effect of dexamethasone on high altitude anorexia. However, reduced insulin sensitivity questions the widespread use of dexamethasone to prevent/treat AMS.
1 Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich , Zurich, Switzerland .
Kerstin
K
Spliethoff
Daniela
D
Meier
Isabelle
I
Aeberli
Max
M
Gassmann
Wolfgang
W
Langhans
Marco
M
Maggiorini
Thomas A
TA
Lutz
Oliver
O
Goetze
D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000097:blood* / Q000188:drug therapy; D001786:Blood Glucose / Q000378:metabolism; D002766:Cholecystokinin / Q000097:blood; D003907:Dexamethasone / Q000627:therapeutic use; D002149:Energy Intake; D004921:Erythropoietin / Q000097:blood; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006706:Homeostasis; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D000860:Hypoxia / Q000097:blood / Q000150:complications; D007333:Insulin Resistance / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000502:physiology; D015850:Interleukin-6 / Q000097:blood; D058228:Islet Amyloid Polypeptide / Q000097:blood; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D001786:Blood Glucose; D005938:Glucocorticoids; D015850:Interleukin-6; D058228:Islet Amyloid Polypeptide; D004921:Erythropoietin; D003907:Dexamethasone; D002766:Cholecystokinin; D010100:Oxygen; D006854:Hydrocortisone