Summary
The study was designed to investigate the influence of androgens on peripheral glucose metabolism in women with congenital adrenal hyperplasia (CAH). Nine normal women and seven women with CAH were studied (4 with the classical form of 21-hydroxylase deficiency [C 21-OH] and 3 with nonclassical 21-hydroxylase deficiency [NC 21-OH]). The study was performed using the forearm model combined with local indirect calorimetry. The insulin level reached 30 minutes after glucose ingestion was significantly greater (p<.05) in patients with CAH. The patients with C 21-OH had elevated androstenedione (A) and testosterone (T) and low DHEA-S and presented a 35% greater insulin response to a glucose stimulus than the control group, area under the curve (AUC) of 9457±887 vs 6989±833 μU/ml · 3 hours. Patients with NC 21-OH had slightly elevated T, A and DHEA-S and presented an insulin response that was similar to the control group, AUC = 7208±1935 μU/ml · 3 hours. Despite the greater muscle mass of the patients with CAH the forearm glucose uptake during the three hours of the study was lower in these patients than in normal women (CAH = 100.9±10.0 vs control group = 132.5±21.2 mg/100ml forearm). The ratio of insulin response to the increment of forearm glucose uptake over a period of 3 h was significantly higher in patients with CAH (control group = 59.6±6.5 vs CAH = 98.6±19.4μU · ml-1/mg · 100ml forearm1, p<0.05). These results suggest that insulin sensitivity is decreased in patients with CAH. The impairment is greater in patients with elevated Δ4 androgens (A and T) and low serum DHEA-S levels.
Key words
Peripheral Glucose Metabolism - Indirect Calorimetry - Androgen - Congenital Adrenal Hyperplasia
