Androgen-Related Effects on Peripheral Glucose Metabolism in Women With Congenital Adrenal Hyperplasia

Paula, Francisco José Albuquerque de; Gouveia, L. M. F. B.; Paccola, G M G F; Piccinato, Carlos Eli; Moreira, Ayrton Custódio; Foss, Milton César

doi:10.1097/00006254-199506000-00018

Cited by 14 publications

(22 citation statements)

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“…In females, reciprocal actions of DHEAS and testosterone on insulin have been proposed, with testosterone showing a positive correlation to stimulated insulin levels and negative to indices of insulin receptor binding, and DHEAS showing the opposite correlations (37). Comparing classical with non classical 21-hydroxylase deficiency (38) and congenital adrenal hyperplasia with polycystic ovary syndrome (39), the observed difference in insulin sensitivity has been explained by the DHEAS to testosterone ratio. Amelioration of insulin resistance in diabetes with DHEA in one female patient has been reported (40).…”

Section: Discussionmentioning

confidence: 99%

Very short term dehydroepiandrosterone treatment in female adrenal failure: impact on carbohydrate, lipid and protein metabolism

Christiansen¹,

Gravholt²,

Fisker³

et al. 2005

eur j endocrinol

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Objective: In female adrenal insufficiency, dehydroepiandrosterone (DHEA) secretion is impaired and circulating androgen levels are severely reduced. We wanted to analyse the acute effects of physiological DHEA substitution on substrate metabolism. Design: We studied nine females with adrenal insufficiency after 9 days of oral DHEA replacement (50 mg/day) in a double-blind, placebo-controlled crossover study. Methods: Whole body and regional substrate metabolism was assayed in the basal state and during a euglycemic hyperinsulinemic glucose clamp by means of isotope dilution techniques (glucose, phenylalanine, tyrosine), indirect calorimetry and in situ lipolysis (microdialysis technique). Results: DHEA treatment normalized the levels of all androgens. Basal and insulin-stimulated total energy expenditure and rates of protein, lipid and glucose oxidation were unaffected by DHEA. Whole body turnover of glucose and protein were also unaffected by DHEA. Forearm breakdown of protein was reduced by insulin to the same extent after placebo and DHEA. Insulin sensitivity as expressed by the glucose infusion rate during the euglycemic clamp was similar after placebo and DHEA. Finally, the interstitial release of glycerol in adipose tissue was not significantly influenced by DHEA. Conclusions: Short-term oral DHEA replacement in women with adrenal insufficiency was not associated with measurable changes in total or regional substrate metabolism.European Journal of Endocrinology 152 77-85

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Section: Discussionmentioning

confidence: 99%

Very short term dehydroepiandrosterone treatment in female adrenal failure: impact on carbohydrate, lipid and protein metabolism

Christiansen¹,

Gravholt²,

Fisker³

et al. 2005

eur j endocrinol

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“…Of the few studies that have explored insulin sensitivity in CAH, most have concluded that CAH patients are indeed characterized by insulin resistance (5)(6)(7)(8)(9)(10)(11). Many different methods have been used to assess insulin sensitivity, but studies using the euglycemic hyperinsulinemic clamp method, the gold standard to assess insulin sensitivity, are lacking.…”

Section: Introductionmentioning

confidence: 99%

Pioglitazone improves insulin resistance and decreases blood pressure in adult patients with congenital adrenal hyperplasia

Kroese

Mooij

Hermus³

et al. 2009

European Journal of Endocrinology

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Context: Patients with congenital adrenal hyperplasia (CAH) are chronically treated with supraphysiological doses of glucocorticoids, which are known to induce insulin resistance. Thiazolidinediones might reverse this effect and improve insulin sensitivity. Objectives: To assess insulin sensitivity in CAH patients and the effect of pioglitazone treatment on insulin sensitivity in CAH patients. Secondary objectives were the effects of treatment with pioglitazone on blood pressure, body fat distribution, lipid, and steroid profiles. Design: Randomized placebo controlled crossover trial. Participants: Twelve CAH patients and 12 body mass and age-matched control subjects. Intervention: Sixteen-week treatment with pioglitazone (45 mg/day) or placebo. Main outcome measure: Insulin sensitivity measured by euglycemic clamp and oral glucose tolerance test. Further measures were 24-h blood pressure profiles, body fat distribution measured by magnetic resonance imaging, dual energy x-ray absorptiometry (DEXA) and bioimpedance procedures, liver fat by magnetic resonance spectroscopy, lipid, and steroid profiles. Results: CAH patients were insulin resistant compared with healthy controls. Treatment with pioglitazone significantly improved insulin sensitivity in CAH patients (glucose infusion rate (GIR) from 28.5G11.6 to 38.9G11.0 mmol/kg per min, PZ0.000, GIR in controls 46.2G23.4 mmol/kg per min, P!0.05 versus CAH). Treatment with pioglitazone decreased blood pressure (systolic: 124.0G13.6 vs 127.0G14.9 mmHg, P!0.001, diastolic: 72.8G11.5 vs 77.4G12.6 mmHg, P!0.001). No changes in body fat distribution, lipid, and steroid profiles were observed. Conclusions: CAH patients are insulin resistant compared with matched control subjects. Treatment with pioglitazone improves insulin sensitivity and decreases blood pressure in CAH patients.

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“…The euglycemic hyperinsulinemic clamp technique is the reference and best method for quantifying insulin sensitivity or resistance in vivo because it directly measures the effects of insulin on glucose utilization under steady state conditions (6). In contrast, the forearm technique to estimate muscle glucose metabolism combined or not with indirect calorimetry directly analyzes the biological action of insulin on a metabolically active tissue, the muscle, and represents a good method to evaluate insulin sensitivity or resistance (9)(10)(11)(12)(13)(14)(15)(16). However, these methods are not easily applied in large-scale or routine clinical investigations because they are laborious and expensive.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the homeostasis model assessment and quantitative insulin sensitivity check index with data from forearm metabolic studies for the in vivo assessment of insulin sensitivity

Foss-Freitas

Foss

2004

Braz J Med Biol Res

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The present study was designed to compare the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) with data from forearm metabolic studies of healthy individuals and of subjects in various pathological states. Fifty-five healthy individuals and 112 patients in various pathological states, including type 2 diabetes mellitus, essential hypertension and others, were studied after an overnight fast and for 3 h after ingestion of 75 g of glucose, by HOMA, QUICKI and the forearm technique to estimate muscle uptake of glucose combined with indirect calorimetry (oxidative and non-oxidative glucose metabolism). The patients showed increased HOMA (1.88 ± 0.14 vs 1.13 ± 0.10 pmol/l x mmol/l) and insulin/glucose (I/G) index (1.058.9 ± 340.9 vs 518.6 ± 70.7 pmol/l x (mg/100 ml forearm) -1 ), and decreased QUICKI (0.36 ± 0.004 vs 0.39 ± 0.006 (µU/ml + mg/dl) -1 ) compared with the healthy individuals. Analysis of the data for the group as a whole (patients and healthy individuals) showed that the estimate of insulin resistance by HOMA was correlated with data obtained in the forearm metabolic studies (glucose uptake: r = -0.16, P = 0.04; non-oxidative glucose metabolism: r = -0.20. P = 0.01, and I/G index: r = 0.17, P = 0.03). The comparison of QUICKI with data of the forearm metabolic studies showed significant correlation between QUICKI and non-oxidative glucose metabolism (r = 0.17, P = 0.03) or I/G index (r = -0.37, P < 0.0001). The HOMA and QUICKI are good estimates of insulin sensitivity as data derived from forearm metabolic studies involving direct measurements of insulin action on muscle glucose metabolism.

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Androgen-Related Effects on Peripheral Glucose Metabolism in Women With Congenital Adrenal Hyperplasia

Cited by 14 publications

References 0 publications

Very short term dehydroepiandrosterone treatment in female adrenal failure: impact on carbohydrate, lipid and protein metabolism

Very short term dehydroepiandrosterone treatment in female adrenal failure: impact on carbohydrate, lipid and protein metabolism

Pioglitazone improves insulin resistance and decreases blood pressure in adult patients with congenital adrenal hyperplasia

Comparison of the homeostasis model assessment and quantitative insulin sensitivity check index with data from forearm metabolic studies for the in vivo assessment of insulin sensitivity

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