Document Detail

Stress dose of hydrocortisone is not beneficial in patients with classic congenital adrenal hyperplasia undergoing short-term, high-intensity exercise.
MedLine Citation:
PMID:  15292287     Owner:  NLM     Status:  MEDLINE    
Classic congenital adrenal hyperplasia (CAH) is associated with impaired function of the adrenal cortex and medulla leading to decreased production of cortisol and epinephrine. As a result, the normal exercise-induced rise in blood glucose is markedly blunted in such individuals. We examined whether an extra dose of hydrocortisone, similar to that given during other forms of physical stress such as intercurrent illness, would normalize blood glucose levels during exercise in patients with CAH. We studied hormonal, metabolic, and cardiorespiratory parameters in response to a standardized high-intensity exercise protocol in nine adolescent patients with classic CAH. Patients were assigned to receive either an additional morning dose of hydrocortisone or placebo, in addition to their usual glucocorticoid and mineralocorticoid replacement in a randomized, double-blind, crossover design 1 h before exercising. Although plasma cortisol levels approximately doubled after administration of the additional hydrocortisone dose compared with the usual single dose, fasting and exercise-induced blood glucose levels did not differ. In addition, no differences were observed in the serum concentrations of the glucose-modulating hormones epinephrine, insulin, glucagon, and GH and of the metabolic parameters lactate and free fatty acids. Although maximal heart rate was slightly higher after stress dosing (193 +/- 3 vs. 191 +/- 3 beats/min, mean +/- sem, P < 0.05), this did not affect exercise performance or perceived exertion. We conclude that patients with classic CAH do not benefit from additional hydrocortisone during short-term, high-intensity exercise. Although this has not been tested with long-term exercise, a high degree of caution should be used when considering the frequent use of additional hydrocortisone administration with exercise, given the adverse side effects of glucocorticoid excess.
Martina Weise; Bart Drinkard; Sarah L Mehlinger; Stuart M Holzer; Graeme Eisenhofer; Evangelia Charmandari; George P Chrousos; Deborah P Merke
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  89     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-08-04     Completed Date:  2004-09-03     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3679-84     Citation Subset:  AIM; IM    
Developmental Endocrinology Branch, National Institutes of Health, Bethesda, Maryland 20892, USA.
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MeSH Terms
Adrenal Hyperplasia, Congenital / blood,  drug therapy*,  physiopathology*
Blood Glucose / analysis
Cross-Over Studies
Dose-Response Relationship, Drug
Double-Blind Method
Fasting / blood
Heart Rate / drug effects
Hormones / blood
Hydrocortisone / administration & dosage*,  blood,  therapeutic use
Physical Endurance
Stress, Physiological / drug therapy
Time Factors
Reg. No./Substance:
0/Blood Glucose; 0/Hormones; 50-23-7/Hydrocortisone
Comment In:
J Clin Endocrinol Metab. 2004 Aug;89(8):3677-8   [PMID:  15292286 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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