Stimulation of both type I and type II corticosteroid receptors blunts counterregulatory responses to subsequent hypoglycemia in healthy man

Am J Physiol Endocrinol Metab. 2008 Mar;294(3):E506-12. doi: 10.1152/ajpendo.00589.2007. Epub 2008 Jan 8.

Abstract

Antecedent increases of corticosteroids can blunt counterregulatory responses to subsequent stress. Our aim was to determine whether prior activation of type I corticosteroid (mineralocorticoid) or type II corticosteroid (glucocorticoid) receptors blunts counterregulatory responses to subsequent hypoglycemia. Healthy volunteers participated in five randomized 2-day protocols. Day 1 involved morning and afternoon 2-h hyperinsulinemic (9 pmol.kg(-1).min(-1)) euglycemic clamps (PE; n = 14), hypoglycemic clamps (PH; n = 14), or euglycemic clamps with oral fludrocortisone (PE + F; type I agonist, 0.2 mg, n = 14), oral dexamethasone (PE + D; type II agonist, 0.75 mg, n = 13), or both (PE + F + D; n = 14). Day 2 was identical in all protocols and consisted of a 2-h hyperinsulinemic hypoglycemic clamp. Day 2 insulin (625 +/- 40 pmol/l) and glucose (2.9 +/- 0.1 mmol/l) levels were similar among groups. Levels of epinephrine, norepinephrine, glucagon, growth hormone, and MSNA were significantly blunted by prior activation of both type I and type II corticosteroid receptors to PE. Prior activation of both corticosteroid receptors also significantly blunted NEFA during subsequent hypoglycemia. Thus, levels of a wide spectrum of key counterregulatory mechanisms (neuroendocrine, ANS, and metabolic) were blunted by antecedent pharmacological stimulation of either type I or type II corticosteroid receptors in healthy man. These data suggest that activation of type I corticosteroid receptors in man can have acute and profound regulating effects on physiological stress in man. Both type I and type II corticosteroid receptors may be involved in the multiple mechanisms controlling counterregulatory responses to hypoglycemia in healthy man.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Dexamethasone / administration & dosage
  • Fatty Acids, Nonesterified / blood
  • Female
  • Fludrocortisone / administration & dosage
  • Glucose Clamp Technique
  • Homeostasis / physiology*
  • Humans
  • Hyperinsulinism
  • Hypoglycemia / physiopathology*
  • Male
  • Receptors, Glucocorticoid / agonists
  • Receptors, Glucocorticoid / drug effects
  • Receptors, Glucocorticoid / physiology*
  • Receptors, Mineralocorticoid / agonists
  • Receptors, Mineralocorticoid / drug effects
  • Receptors, Mineralocorticoid / physiology*

Substances

  • Blood Glucose
  • Fatty Acids, Nonesterified
  • Receptors, Glucocorticoid
  • Receptors, Mineralocorticoid
  • Dexamethasone
  • Fludrocortisone