Effects of Estrogen Therapy on Cortisol Metabolism

Grant, Sylvia D.; Pavlatos, Fotios Ch.; Forsham, Peter H.

doi:10.1210/jcem-25-8-1057

Cited by 32 publications

(10 citation statements)

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“…However, our finding of menstrual cycle phase-related changes in cortisol response to dexametha sone in normal subjects, in conjunction with similar findings in depressed subjects reported by Tandon et al [1985], suggest that hypothalamic-pituitary-adrenal axis dysfunction in PMS might be characterized by an ab sence of this menstrual cycle phase-related pattern. The mechanism of a menstrual cycle phase-related change in post-dexamethasone cortisol may involve an estrogeninduced increase in cortisol-binding globulin and total cortisol without any alteration in free (physiologic) corti sol [Grant et al, 1965], If so, the absence of a menstrual cycle phase-related change in post-dexamethasone corti sol in patients with PMS may provide indirect evidence of a reproductive endocrine-related abnormality in this patient group.…”

Section: Discussionmentioning

confidence: 97%

Cortisol Response to Dexamethasone in Women with Premenstrual Syndrome

et al. 1986

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There were no significant differences in post-dexamethasone cortisol between the follicular and luteal phase of the menstrual cycle in both women with premenstrual syndrome (PMS) and control subjects tested on these two occasions. Within each menstrual cycle phase, there were also no differences in post-dexamethasone cortisol between the two groups. In a second group of control subjects tested on a single occasion, post-dexamethasone cortisol values were higher when subjects were tested in the middle 2 weeks of the menstrual cycle compared with the first and last weeks of the cycle. This phenomenon, possibly due to estrogen effects, suggests that post-dexamethasone cortisol should be assessed weekly in women with PMS to determine whether they also manifest this normally observed menstrual cycle phase-related pattern, or whether it is absent, reflecting a reproductive endocrine abnormality in this patient group.

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Section: Discussionmentioning

confidence: 97%

Cortisol Response to Dexamethasone in Women with Premenstrual Syndrome

et al. 1986

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“…In addition to gonadal suppression (7) estrogen administration is associated with reduced cortisol secretion (8,9). In men adrenal sup-pression resulted in a significantly greater fall in pregnenolone levels than did testicular suppression.…”

Section: Discussionmentioning

confidence: 99%

Pregnenolone in Man: Plasma Levels in States of Normal and Abnormal Steroidogenesis¹

McKenna

1974

The Journal of Clinical Endocrinology & Metabolism

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Using a recently described radioimmunoassay, plasma pregnenolone was measured in subjects with normal and abnormal steroidogenesis. Plasma levels were found to be higher in premenopausal women than men and higher in men than in postmenopausal women. Adrenal suppression decreased plasma pregnenolone in normal subjects and gonadal suppression decreased plasma pregnenolone in premenopausal women and men but not in postmenopausal women. Adrenal plus gonadal suppression reduced plasma pregnenolone levels below the sensitivity of the assay i.e., <0.1 ng/ml. Plasma pregnenolone was similar during the follicular and luteal phases of 4 menstrual cycles. Plasma pregnenolone rose in response to the administration of large doses of ACTH to 5 normal subjects. A diurnal rhythm of plasma pregnenolone was observed only in postmenopausal women and in premenopausal women taking estrogen. This suggests that pregnenolone of ovarian origin may have obscured a diurnal rhythm of adrenal pregnenolone in premenopausal women not taking estrogen.The range of plasma pregnenolone in patients with Cushing's syndrome is similar to that of normal subjects. This observation suggests increased intraadrenal turnover of pregnenolone in these patients since plasma fluorogenic corticosteroids were higher in them than in normal subjects. Patients with primary aldosteronism had plasma pregnenolone levels similar to those of normal subjects. ( / Clin Endocrinol Metab 38: 480,1974) P REGNENOLONE is an important intermediate in gonadal and adrenal steroidogenesis. Recent communications (1,2, 3) have reported basal plasma pregnenolone levels in normal subjects. In addition to control values we have measured plasma pregnenolone levels in normal subjects during adrenal stimulation and adrenal suppression, gonadal suppression and combined adrenal and gonadal suppression. Morning and evening plasma pregnenolone levels in normal subjects have been compared. Plasma pregnenolone has been measured in patients with Cushing's syndrome (both those with adrenal hyperplasia and those with adrenal adenomata) during a control period and following dexamethasone administration. Patients

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“…Earlier reports described a cortisol suppression in some women under contraceptive treatment which, according to these criteria, must be considered inadequate. Grant et al (1965) reported about an insufficient fall of cortisol levels (from 44.9 to 7.6 ig/dl) after 1 mg of dexamethasone in 3 out of 5 women taking contraceptives with a high amount f estrogen (0.06 or 0.1 mg mestranol); similar values were observed in 3 out of 4 subjects who received a daily dose of 4 X 0.5 mg ethinyl estradiol. In 1977, Treece et al reported about a study with 6 women receiving Premarin (= 1.25 mg conjugated equine estrogens), who had significantly higher postdexamethasone cortisol levels when compared to a control group but cortisol suppression below 5 ig/dl in all cases.…”

Section: Discussionmentioning

confidence: 73%

“…It is well established that elevated estrogen levels in blood lead to hypercortisolaemia by stimulating the synthesis of CBG (Doe et al, 1967). This dose-dependent effect usually occurs within two weeks after the beginning of estrogen treatment (Musa et al, 1965) and persists for a period of four weeks after medication has been discontinued (Grant et al, 1965).…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, some controversy has remained with regard to its reliability in patients with elevated plasma estrogen levels. 'n several investigations carried out in the 60's and early 70's, the suppression of cortisol levels after an overnight dexamethasone test was diminished and sometimes insufficient in healthy women taking oral contraceptives (Grant et al, 1965;Treece et al, 1977), a finding which was recently confirmed (Allolio et al,198G). As a result, several groups have suggested replacing the measurement of total serum cortisol by the determination of unbound cortisol in saliva in any cases of hyperestrogenaemia (Allolio et al, 1986;Al-Ansari et al, 1982).…”

Section: Introductionmentioning

confidence: 89%

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The Dexamethasone Suppression Test and Long-Term Contraceptive Treatment: Measurement of ACTH or Salivary Cortisol Does Not Improve the Reliability of the Test

Nickelsen

Lissner²,

Schöffling³

2009

Exp Clin Endocrinol Diabetes

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Under the influence of high estrogen levels, the suppression of total serum cortisol in the dexamethasone test has often been found to be incomplete. Its measurement for the purpose of excluding Cushing's disease or adrenal tumors in women taking oral contraceptives is, therefore, considered unreliable. This study was designed to compare the reliability of measurements of total cortisol, unbound cortisol and ACTH suppression during chronic hyperestrogenaemia. An overnight suppression test with 2 mg of dexamethasone was performed in 19 women receiving long-term contraceptive treatment (group A) and in 12 controls (group C). Baseline and post-dexamethasone morning levels of ACTH, total serum cortisol and unbound salivary cortisol were determined by RIA. In addition, unbound serum cortisol was measured by equilibrium dialysis. Mean baseline levels of all four parameters were significantly higher in group A. This result points towards the possibility of a direct stimulatory effect of estrogens upon the corticotroph axis which is independent from CBG-mediated increase of total cortisol. Post-dexamethasone values of total and unbound cortisol showed no statistically significant differences, while ACTH suppression in group A was even slightly better than in group C. From these data it is concluded that there is no need for post-dexa routine measurement of ACTH or unbound cortisol under contraceptive treatment since neither one of these parameters provides any additional information in comparison to total cortisol.

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Effects of Estrogen Therapy on Cortisol Metabolism

Cited by 32 publications

References 0 publications

Cortisol Response to Dexamethasone in Women with Premenstrual Syndrome

Cortisol Response to Dexamethasone in Women with Premenstrual Syndrome

Pregnenolone in Man: Plasma Levels in States of Normal and Abnormal Steroidogenesis¹

The Dexamethasone Suppression Test and Long-Term Contraceptive Treatment: Measurement of ACTH or Salivary Cortisol Does Not Improve the Reliability of the Test

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Effects of Estrogen Therapy on Cortisol Metabolism

Cited by 32 publications

References 0 publications

Cortisol Response to Dexamethasone in Women with Premenstrual Syndrome

Cortisol Response to Dexamethasone in Women with Premenstrual Syndrome

Pregnenolone in Man: Plasma Levels in States of Normal and Abnormal Steroidogenesis1

The Dexamethasone Suppression Test and Long-Term Contraceptive Treatment: Measurement of ACTH or Salivary Cortisol Does Not Improve the Reliability of the Test

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Pregnenolone in Man: Plasma Levels in States of Normal and Abnormal Steroidogenesis¹