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Supraphysiological Hyperinsulinemia Acutely Increases Hypothalamic-Pituitary-Adrenal Secretory Activity in Humans

Departments of Internal Medicine I (B.F.-S., W.K., W.B., P.W., H.L.F., A.P.) and Clinical Neuroendocrinology (J.B.), University of Luebeck, D-23538 Luebeck; and Department of Diabetes and Metabolism (W.K.), Klinikum Karlsburg, D-17495 Karlsburg, Germany

Address all correspondence and requests for reprints to: Bernd Fruehwald-Schultes, M.D., Medical University Luebeck Department of Internal Medicine I, Ratzeburger Allee 160, D-23538 Luebeck, Germany. E-mail: fruehwal{at}kfg.mu-luebeck.de

Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in association with hyperinsulinemia is frequently found in patients with type 1 and type 2 diabetes mellitus and in subjects with abdominal adiposity. We questioned whether insulin could cause HPA axis activation and, if so, whether this insulin action may arise at the adrenal level or at a central (i.e. hypothalamic-pituitary) level. Experiments lasting for 6 h each were done in 30 lean healthy men. In 15 men, insulin was infused at a rate of 1.5 mU min^-1kg^-1. Plasma glucose concentration was held constant during an euglycemic clamp session and was decreased stepwise in a hypoglycemic clamp session. The sequence of the 2 clamp sessions was random, and a 4-weeks recovery period was allowed between the two sessions. The protocol was essentially the same in another 15 men, with the exception that insulin was infused at a rate of 15.0 mU min^-1kg^-1. During the euglycemic clamp sessions, we found plasma ACTH levels to increase only in the high-, but not in the low-insulin group (group by time interaction, P < 0.01); serum cortisol levels were greater in the high than in the low-insulin group (P < 0.02). In the hypoglycemic clamp sessions, plasma ACTH levels increased in the same pattern in the 2 groups; serum cortisol was greater in the high than in the low-insulin group at the beginning of the clamp (plasma glucose 4.1 mmol/L; P < 0.05). Our results demonstrate that insulin acutely stimulates the HPA secretory activity in humans. The pattern suggests an effect of insulin at both peripheral and central levels of the HPA axis.

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