Using gas chromatography/mass spectrometry, urinary excretion rates of cortisol, cortisone and of various steroid metabolites were determined in 35 acromegalic patients (18 men, 17 women) and in 45 age- and weight-matched controls. The ratio of excreted cortisol/cortisone was similar in acromegalics (0.75 ± 0.20) and in controls (0.75 ± 0.24). Hence, the preponderance of the main cortisone-derived metabolite, tetrahydrocortisone, over the main metabolites of cortisol (tetrahydrocortisol and allotetrahydrocortisol; p < 0.01), which was seen both in female and in male acromegalics and which was directly correlated with the postglucose concentrations of growth hormone (r = 0.508, p < 0.01), suggests a decreased activity of 11β-hydroxysteroid dehydrogenase type 1 in acromegaly. Furthermore, the preponderance of etiocholanolone over androsterone (p < 0.01) in men (though not in women) with acromegaly – the ratio androsterone/etiocholanolone being negatively correlated with the serum concentrations of insulin-like growth factor type 1 (r = –0.406, p < 0.05) – suggests a relatively reduced activity of hepatic 5α-reductase in male acromegalics.

1.
Vierhapper H, Nowotny P, Waldhäusl W: Unchanged testosterone production rates in growth hormone treated healthy men. J Clin Endocrinol Metab 1998;83:3735–3736.
2.
Roelfsema F, Moolenaar AJ, Frölich M: The influence of bromocriptine and transsphenoidal surgery on urinary androgen metabolite excretion in acromegaly. Acta Endocrinol Copenh 1984;107:302–311.
3.
Weaver JU, Thaventhiran L, Noonan K, Burrin JM, Taylor NF, Norman MR, Monson JP: The effect of growth hormone replacement on cortisol metabolism and glucocorticoid sensitivity in hypopituitary adults. Clin Endocrinol 1994;41:639–648.
4.
Vierhapper H, Nowotny P, Waldhäusl W: Treatment with growth hormone suppresses cortisol production in man. Metabolism 1998;47:1376–1378.
5.
Gelding SV, Taylor NF, Wood PJ, Noonan K, Weaver JU, Wood DF, Monson JP: The effect of growth hormone replacement therapy on cortisol-cortisone interconversion in hypopituitary adults: Evidence for growth hormone modulation of extrarenal 11 beta-hydroxysteroid dehydrogenase activity. Clin Endocrinol 1998;48:153–162.
6.
Moore JS, Monson JP, Kaltsas G, Putignano P, Wood PJ, Sheppard MC, Besser GM, Taylor NF, Stewart PM: Modulation of 11 beta-hydroxysteroid dehydrogenase isozymes by growth hormone and insulin-like growth factor: In vivo and in vitro studies. J Clin Endocrinol Metab 1999;84:4172–4177.
7.
Trainer PJ, Drake WM, Perry LA, Taylor NF, Besser GM, Monson JP: Modulation of cortisol metabolism by the growth hormone receptor antagonist pegvisomant in patients with acromegaly. J Clin Endocrinol Metab 2001;86:2989–2992.
8.
Palermo M, Shackleton CH, Mantero F, Stewart PM: Urinary free cortisone and the assessment of 11 beta-hydroxysteroid dehydrogenase activity in man. Clin Endocrinol (Oxf) 1996;45:605–611.
9.
Tomlinson JW, Crabtree N, Clark PMS, Holder G, Toogood AA, Shackleton CHL, Stewart PM: Low-dose growth hormone inhibits 11 beta-hydroxysteroid dehydrogenase type 1 but has no effect upon fat mass in patients with simple obesity. J Clin Endocrinol Metab 2003;88:2113–2118.
10.
Vierhapper H, Heinze G, Gessl A, Exner M, Bieglmayr C: Use of the oral glucose tolerance test to define remission in acromegaly. Metabolism 2003;52:181–185.
11.
Vierhapper H, Nowotny P, Waldhäusl W: Stimulation of gonadal steroid synthesis by chronic excess of adrenocorticotropin in patients with adrenocortical insufficiency. J Clin Invest 1986;77:1063–1070.
12.
Vierhapper H, Nowotny P: The stress of being a doctor: Steroid excretion rates in internal medicine residents on and off duty. Am J Med 2000;109:492–494.
13.
Frajese GV, Taylor NF, Jenkins PJ, Besser GM, Monson JP: Modulation of cortisol metabolism during treatment of acromegaly is independent of body composition and insulin sensitivity. Horm Res 2004;61:246–251.
14.
Colao A, Derosa M, Pivonello R, Balestrieri A, Cappabianca P, Disarno A, Rochira V, Carani C, Lombardi G: Short-term suppression of GH and IGF-I levels improves gonadal function and sperm parameters in men with acromegaly. J Clin Endocrinol Metab 2002;87:4193–4197.
15.
Andrew R, Phillips DIW, Walker BR: Obesity and gender influence cortisol secretion and metabolism in man. J Clin Endocrinol Metab 1998;83:1806–1809.
16.
Rask E, Olsson T, Soderberg S, Andrew R, Livingstone DE, Johnson O, Walker BR: Tissue-specific dysregulation of cortisol metabolism in human obesity. J Clin Endocrinol Metab 2001;86:1418–1421.
17.
Stewart PM, Boulton A, Kumar S, Clark PMS, Shackleton CHL: Cortisol metabolism in human obesity: Impaired cortisone → cortisol conversion in subjects with central adiposity. J Clin Endocrinol Metab 1999;84:1022–1027.
18.
Paulmyer-Lacroix O, Boullu S, Oliver C, Alessi MC, Grino M: Expression of the mRNA coding for 11 beta-hydroxysteroid dehydrogenase type 1 in adipose tissue from obese patients: An in situ hybridization study. J Clin Endocrinol Metab 2002;87:2701–2705.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.