This Article Full Text Full Text (PDF) Submit a related Letter to the Editor 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 Green-Golan, L. Articles by Merke, D. P. Search for Related Content PubMed PubMed Citation Articles by Green-Golan, L. Articles by Merke, D. P. Related Collections Adrenal and Hypertension Pediatric Endocrinology Metabolism

Patients with Classic Congenital Adrenal Hyperplasia Have Decreased Epinephrine Reserve and Defective Glycemic Control during Prolonged Moderate-Intensity Exercise

National Institutes of Health Clinical Center (L.G.-G., C.V., D.P.M.), Pediatric Endocrinology (C.Y.), Walter Reed Army Medical Center, Washington, D.C. 20307; and Rehabilitation Medicine Department (B.D.), Clinical Neurocardiology Section (G.E.) of National Institute of Neurological Disorders and Stroke, Reproductive Biology and Medicine Branch (M.W., D.P.M.) of National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Deborah P. Merke, M.D., M.S., National Institutes of Health Clinical Center, Building 10-CRC, Room 1-2740, Bethesda, Maryland 20892-1932. E-mail: dmerke{at}mail.nih.gov.

Context: Patients with classic congenital adrenal hyperplasia (CAH) have adrenomedullary dysplasia and hypofunction, and their lack of adrenomedullary reserve has been associated with a defective glucose response to brief high-intensity exercise.

Objective: Our objective was to assess hormonal, metabolic, and cardiovascular response to prolonged moderate-intensity exercise comparable to brisk walking in adolescents with classic CAH.

Subjects and Methods: We compared six adolescents with classic CAH (16–20 yr old) with seven age-, sex-, and body mass index group-matched controls (16–23 yr old) using a 90-min standardized ergometer test. Metabolic, hormonal, and cardiovascular parameters were studied during exercise and recovery.

Results: Glucose did not change throughout exercise and recovery for controls, whereas CAH patients showed a steady decline in glucose during exercise with an increase in glucose in the postexercise period. Glucose levels were significantly lower in CAH patients at 60 (P = 0.04), 75 (P = 0.01), and 90 (P = 0.03) min of exercise and 15 (P = 0.02) min post exercise, whereas glucose levels were comparable between the two groups early in exercise and at 30 min (P = 0.19) post exercise. As compared with controls, CAH patients had significantly lower epinephrine (P = 0.002) and cortisol (P 0.001) levels throughout the study and similar norepinephrine, glucagon, and GH levels. Patients with CAH and controls had comparable cardiovascular parameters and perceived level of exertion. Despite having lower glucose levels, insulin levels were slightly higher in CAH patients during the testing period (P = 0.17), suggesting insulin insensitivity.

Conclusion: CAH patients have defective glycemic control and altered metabolic and hormonal responses during prolonged moderate-intensity exercise comparable to brisk walking.

This article has been cited by other articles:

				D. P. Merke Approach to the Adult with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 653 - 660. [Abstract] [Full Text] [PDF]