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The effects of growth hormone deficiency and replacement on glucocorticoid exposure in hypopituitary patients on cortisone acetate and hydrocortisone replacement

The effects of growth hormone deficiency and replacement on glucocorticoid exposure in hypopituitary patients on cortisone acetate and hydrocortisone replacement
The effects of growth hormone deficiency and replacement on glucocorticoid exposure in hypopituitary patients on cortisone acetate and hydrocortisone replacement
Objective 11?-hydroxysteroid dehydrogenase type 1 (11?HSD1) converts inactive cortisone to active cortisol. 11?HSD1 activity is increased in GH deficiency and inhibited by GH and IGF-I in acromegaly. However it is not known whether these changes in cortisol metabolism exert significant effects during hydrocortisone therapy, and the effect has not been studied in patients taking cortisone acetate. We have studied the effect of GH induced 11?HSD1 inhibition in hypopituitary adults with severe GH deficiency to determine whether this inhibition has a different magnitude of effect when patients are taking different forms of glucocorticoid replacement therapy.
Design, patients and measurements We have taken the ratio of 11-hydroxy/11-oxo cortisol metabolites (Fm/Em), an established measure of net 11?HSD activity to reflect the likely balance of cortisol to cortisone exposure in tissues expressing 11?HSD1, principally the liver and adipose tissue. We recruited 10 hypopituitary adults all on established glucocorticoid replacement therapy, but who were not receiving GH. Patients were treated with their standard hydrocortisone therapy for one week and an equivalent dose of cortisone acetate in its place for one week in random order. Serial serum cortisol assessments and urine steroid profiles were performed on each treatment. All patients were then established on GH therapy for at least three months before the two-week cycle was repeated. Fm/Em was also measured in a control population (20F, 20M).
Results Prior to GH, the ratio Fm/Em was greater with hydrocortisone compared with cortisone acetate replacement (1·17 ± 0·28 and 0·52 ± 0·09 respectively, P < 0·001) or with normal subjects (normal males: 0·81 ± 0·24, females 0·66 ± 0·14). Following GH replacement Fm/Em fell in patients on hydrocortisone and cortisone acetate (Pre-GH: 0·84 ± 0·40, Post-GH: 0·70 ± 0·34, P < 0·05) confirming the inhibition of 11?HSD1 by GH/IGF-I. Conversely, the ratio of urinary free cortisol/cortisone did not change indicating unchanged 11?HSD2 activity. Mean circulating cortisol also fell in all subjects after GH. This effect was greater during cortisone acetate treatment (?18·7%, P < 0·0001), than during hydrocortisone replacement (?10·9%, P < 0·05).
Conclusions Our data suggest that tissue exposure to glucocorticoid is supra-physiological in hypopituitary patients with untreated GH deficiency taking hydrocortisone replacement therapy. This situation is ameliorated by GH replacement therapy. However, local and circulating cortisol concentrations are more vulnerable to the inhibitory effect of GH on 11?HSD1 in patients taking cortisone acetate, such that serum cortisol assessments should be made in patients taking cortisone acetate after GH therapy to ensure that glucocorticoid replacement remains adequate.
therapy, aged, prospective studies, metabolism, middle aged, humans, deficiency, population, activity, comparative study, endocrinology, cortisone, hydrocortisone
0804-4643
613-620
Swords, F.M.
87b8211a-012f-4329-910c-1d10dfef5e20
Carroll, P.V.
b88e3138-ed66-4205-9d02-9b5bbc68f5b1
Kisalu, J.
c1149f67-6065-4d60-b8e7-d8f07da249e6
Wood, P.J.
f0dfe718-fa0f-43b1-9b2d-4bdc9c41320a
Taylor, N.F.
711d5af3-290c-4e40-88a6-fcc235c126a9
Monson, J.P.
d4f6d2ff-243d-45d3-b475-8351eb231f5b
Swords, F.M.
87b8211a-012f-4329-910c-1d10dfef5e20
Carroll, P.V.
b88e3138-ed66-4205-9d02-9b5bbc68f5b1
Kisalu, J.
c1149f67-6065-4d60-b8e7-d8f07da249e6
Wood, P.J.
f0dfe718-fa0f-43b1-9b2d-4bdc9c41320a
Taylor, N.F.
711d5af3-290c-4e40-88a6-fcc235c126a9
Monson, J.P.
d4f6d2ff-243d-45d3-b475-8351eb231f5b

Swords, F.M., Carroll, P.V., Kisalu, J., Wood, P.J., Taylor, N.F. and Monson, J.P. (2003) The effects of growth hormone deficiency and replacement on glucocorticoid exposure in hypopituitary patients on cortisone acetate and hydrocortisone replacement. European journal of endocrinology, 59 (5), 613-620. (doi:10.1046/j.1365-2265.2003.01894.x).

Record type: Article

Abstract

Objective 11?-hydroxysteroid dehydrogenase type 1 (11?HSD1) converts inactive cortisone to active cortisol. 11?HSD1 activity is increased in GH deficiency and inhibited by GH and IGF-I in acromegaly. However it is not known whether these changes in cortisol metabolism exert significant effects during hydrocortisone therapy, and the effect has not been studied in patients taking cortisone acetate. We have studied the effect of GH induced 11?HSD1 inhibition in hypopituitary adults with severe GH deficiency to determine whether this inhibition has a different magnitude of effect when patients are taking different forms of glucocorticoid replacement therapy.
Design, patients and measurements We have taken the ratio of 11-hydroxy/11-oxo cortisol metabolites (Fm/Em), an established measure of net 11?HSD activity to reflect the likely balance of cortisol to cortisone exposure in tissues expressing 11?HSD1, principally the liver and adipose tissue. We recruited 10 hypopituitary adults all on established glucocorticoid replacement therapy, but who were not receiving GH. Patients were treated with their standard hydrocortisone therapy for one week and an equivalent dose of cortisone acetate in its place for one week in random order. Serial serum cortisol assessments and urine steroid profiles were performed on each treatment. All patients were then established on GH therapy for at least three months before the two-week cycle was repeated. Fm/Em was also measured in a control population (20F, 20M).
Results Prior to GH, the ratio Fm/Em was greater with hydrocortisone compared with cortisone acetate replacement (1·17 ± 0·28 and 0·52 ± 0·09 respectively, P < 0·001) or with normal subjects (normal males: 0·81 ± 0·24, females 0·66 ± 0·14). Following GH replacement Fm/Em fell in patients on hydrocortisone and cortisone acetate (Pre-GH: 0·84 ± 0·40, Post-GH: 0·70 ± 0·34, P < 0·05) confirming the inhibition of 11?HSD1 by GH/IGF-I. Conversely, the ratio of urinary free cortisol/cortisone did not change indicating unchanged 11?HSD2 activity. Mean circulating cortisol also fell in all subjects after GH. This effect was greater during cortisone acetate treatment (?18·7%, P < 0·0001), than during hydrocortisone replacement (?10·9%, P < 0·05).
Conclusions Our data suggest that tissue exposure to glucocorticoid is supra-physiological in hypopituitary patients with untreated GH deficiency taking hydrocortisone replacement therapy. This situation is ameliorated by GH replacement therapy. However, local and circulating cortisol concentrations are more vulnerable to the inhibitory effect of GH on 11?HSD1 in patients taking cortisone acetate, such that serum cortisol assessments should be made in patients taking cortisone acetate after GH therapy to ensure that glucocorticoid replacement remains adequate.

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Published date: 23 October 2003
Keywords: therapy, aged, prospective studies, metabolism, middle aged, humans, deficiency, population, activity, comparative study, endocrinology, cortisone, hydrocortisone

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Local EPrints ID: 60278
URI: http://eprints.soton.ac.uk/id/eprint/60278
ISSN: 0804-4643
PURE UUID: 039ecaca-1846-4485-a29a-0208876e621f

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Date deposited: 08 Sep 2008
Last modified: 15 Mar 2024 11:19

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Contributors

Author: F.M. Swords
Author: P.V. Carroll
Author: J. Kisalu
Author: P.J. Wood
Author: N.F. Taylor
Author: J.P. Monson

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