This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weise, M. Articles by Merke, D. P. Search for Related Content PubMed PubMed Citation Articles by Weise, M. Articles by Merke, D. P.

Stress Dose of Hydrocortisone Is Not Beneficial in Patients with Classic Congenital Adrenal Hyperplasia Undergoing Short-Term, High-Intensity Exercise

Pediatric and Reproductive Endocrinology Branch (S.L.M., S.M.H., E.C., G.P.C., D.P.M.), Developmental Endocrinology Branch (M.W.), National Institute of Child Health and Human Development, The Warren Grant Magnuson Clinical Center (B.D., D.P.M.) and Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke (G.E.), National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Deborah P. Merke, M.D., National Institutes of Health Clinical Center, Building 10, Room 13S260, 10 Center Drive MSC 1932, Bethesda Maryland 20892-1932. E-mail: dmerke{at}nih.gov.

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.

D.P.M. is a commissioned officer in the United States Public Health Service.

Abbreviations: BMI, Body mass index; CAH, congenital adrenal hyperplasia; E, epinephrine; FFA, free fatty acids; HPA, hypothalamic-pituitary-adrenal; NE, norepinephrine; VCO₂, measurement of carbon dioxide production; VO₂, measurement of oxygen uptake; VO₂ max, maximal aerobic capacity.

This article has been cited by other articles:

				L. Green-Golan, C. Yates, B. Drinkard, C. VanRyzin, G. Eisenhofer, M. Weise, and D. P. Merke Patients with Classic Congenital Adrenal Hyperplasia Have Decreased Epinephrine Reserve and Defective Glycemic Control during Prolonged Moderate-Intensity Exercise J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 3019 - 3024. [Abstract] [Full Text] [PDF]

				D. I. Shulman, M. R. Palmert, S. F. Kemp, and for the Lawson Wilkins Drug and Therapeutics Commi Adrenal Insufficiency: Still a Cause of Morbidity and Death in Childhood Pediatrics, February 1, 2007; 119(2): e484 - e494. [Abstract] [Full Text] [PDF]