Abstract
The pituitary-adrenocortical and adrenomedullary response to high altitude (HA) stress was studied following daily single dose administration of prednisolone as a prophylaxis against altitude-induced acute mountain sickness (AMS). Forty healthy men, randomly divided into two groups of twenty, received placebo or prednisolone 20 mg once a day at 08.00 h for two days prior to induction to HA and during an initial three days stay at an altitude of 3450 m. The AMS score and circulatory levels of ACTH, cortisol, epinephrine and norepinephrine were measured at sea level (SL) and during residency at HA. The sensitivity of the hypothalamic-pituitary-adrenal axis in subjects receiving prednisolone therapy was evaluated at SL and on day four of stay at HA. Administration of prednisolone significantly (p < 0.01) decreased the severity of AMS in all the subjects. The steroid dose used did not inhibit endogenous secretion of ACTH, cortisol, epinephrine or norepinephrine, as HA response to adrenocortical and adrenomedullary hormones was identical in placebo and prednisolone treated subjects. The integrity of the hypothalamic-pituitary-adrenal axis was maintained well in subjects receiving low dose prednisolone therapy. These observations suggest that short-term administration of prednisolone is able to curtail AMS without causing suppression of the hypothalamic-pituitary-adrenal axis.
Key words
High Altitude - Acute Mountain Sickness - HPA Axis - Glucocorticoids
References
-
1
Bartsch P, Shaw S, Franciolli M, Gnadinger M P, Weidmann P.
Atrial natriuretic peptide in acute mountain sickness.
J Appl Physiol.
1987;
65
1929 - 1937
-
2
Mazzeo R S, Wolfel E E, Butterfield G E, Reeves J T.
Sympathetic responses during 21 days at high altitude (4 300 m) as determined by urinary and arterial catecholamines.
Metabolism.
1994;
43
1226-1232
-
3
Sawhney R C, Malhotra A S, Singh T.
Glucoregulatory hormones in man at high altitude.
Eur J Appl Physiol.
1991;
62
286-291
-
4
Mordes J P, Blume F D, Boyer S, Zheng M R, Braverman L E.
High altitude pituitary thyroid dysfunction on Mount Everest.
N Engl J Med.
1995;
308
1135-1138
-
5
Hackett P H.
High altitude cerebral edema and acute mountain sickness. A pathophysiology update.
Adv Exp Med Biol.
1999;
474
23 - 25
-
6 White P C, Pescovitz O H, Cutler Jr. G B. Synthesis and metabolism of corticosteroids. In: Becker KL (ed) Principles and Practice of Endocrinology and Metabolism. Philadelphia; Lippincott, Williams & Wilkins 1995: 647-661
-
7
Ellsworth A J, Larson E B, Strickland D A.
Randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis.
Am J Med.
1987;
83
1024-1030
-
8
Hackett P H, Roach R C, Wood R A, Foutch R G, Meehan R T, Rennie D, Mills Jr. W J.
Dexamethasone for prevention and treatment of acute mountain sickness.
Aviat Space Environ Med.
1988;
59
950-955
-
9
Johnson T S, Rock P B, Fulco C S, Trad L A, Spark R F, Maher J T.
Prevention of acute mountain sickness by dexamethasone.
N Engl J Med.
1984;
310
683 - 686
-
10
Ferrazzini G, Maggiorini M, Kriemler S, Bartsch P, Oelz O.
Successful treatment of acute mountain sickness with dexamethasone.
BMJ.
1987;
294
1380 - 1382
-
11
Dickek H L, Niemen L K, Oldfield E H.
A comparison of standard high dose dexamethasone suppression test and overnight 8 mg dexamethasone suppression test for the differential diagnosis of adreno-corticotropin-dependent cushing’s syndrome.
J Clin Endocrinol Metab.
1994;
78
418-422
-
12 Roach R C, Bartsch P, Hackett P H, Oelz O. The Lake Louise acute mountain sickness scoring system. In: Sutton JR, Coates G, Houston CS (eds.) Hypoxia and molecular medicine: Proceedings of the 8th International hypoxia symposium. Lake Louise, Canada. Burlington; VT: Queen city printers Inc 1993: 272-274
-
13
Keller H R, Maggiorini M, Bartsch P, Oelz O.
Simulated descent vs. dexamethasone in treatment of acute mountain sickness: a randomized trial.
BMJ.
1995;
310
1232-1235
-
14
Bernhard W N, Schalick L M, Delaney P A, Bernhard T M, Barnas G M.
Acetazolamide plus low-dose dexamethasone is better than acetazolamide alone to ameliorate symptoms of acute mountain sickness.
Aviat Space Environ Med.
1998;
69
883-886
-
15
Oelkens W.
Adnernal insufficiency.
N Eng J Med.
1996;
335
1206-1212
-
16
Kranser A S.
Glucocorticoid-induced adrenal insufficiency.
JAMA.
1999;
282
671-676
-
17
Henzen C, Suter A, Lerch E, Urbenelli R, Schomo X H, Briner V A.
Supression and recovery of adrenal response after short-term, high dose glucocorticoid treatment.
The Lancet.
2000;
355
542-545
-
18
Carella M J, Srivastava L S, Gossain V V, Rovner D R.
Hypothalamic-pituitary-adrenal function one week after a short burst of steroid therapy.
J Clin Endocrinol Metab.
1993;
76
1181-1191
-
19
Axelrod L.
Glucocorticoid therapy.
Medicine.
1976;
55
36-65
-
20
Nichols T, Nugent C A, Tyler F H.
Diurnal variation in suppression of adrenal function by glucocoticods.
J Clin Endocrinol.
1965;
25
343-349
-
21
Darlington D N, Chew G, Ha T, Keil L C, Dllamanl M F.
Corticosterone, but not glucose, treatment enables fasted adrenalectomised rats to survive moderate hemorrhage.
Endocrinology.
1990;
127
766-772
-
22
Hackett P H, Roach R C.
High altitude illness.
N Engl J Med.
2001;
345
107-114
-
23
Jensen J B, Sperling B, Severinghaus J W, Lassen N A.
Augmented hypoxic cerebral vasodilatation in men during 5 days at 3810 m altitude.
J Appl Physiol.
1996;
80
1214-1218
-
24 Levine B D, Zhang R, Roach R C. Dynamic cerebral autoregulation at high altitude. In. Roach RC, Wagner PD, Hackett PH (eds). Hypoxia: into the next millennium. Vol 474 of Advances in experimental medicine and biology. New York; Kluwer Academic/Plenum 1999: 319-322
-
25
Krasney J A.
A neurogenic basis for acute altitude sickness.
Med Sci Sports Exerc.
1994;
26
195-208
-
26
Hackett P H, Rennie D.
Acute mountain sickness.
Semin Res Med.
1983;
5
132 - 140
-
27
Cruz J C, Denniston J C, Groven R F.
Acute mountain sickness severity in eucapnic hypoxia.
Aviat Space Environ Med.
1975;
46
826 - 829
-
28
Johansson B B.
Effect of dexamethasone on protein extravasation in the brain in acute hypertension induced by amphetamine.
Acta Neur Scand.
1978;
57
180-185
-
29
Cunningham W L, Becker E J, Krenzer A F.
Catecholamines in plasma and urine at high altitude.
J Appl Physiol.
1965;
20
607 - 610
-
30
Hoon R S, Sharma S C, Balasubramanian V, Chadha K S.
Urinary catecholamine excretion on induction to high altitude (3658 m) by air and road.
Am J Physiol.
1977;
42
728
-
31
Eccourrou P, Johnson D G, Rowell L B.
Hypoxemia increases plasma catecholamine concentrations in exercising humans.
J Appl Physiol.
1984;
57
1507 - 1511
-
32
Mazzeo R S, Bender P R, Brooks G A, Butterfield G E, Groves B M, Sutton J R, Wolfel E E, Reeves J T.
Arterial catecholamine responses during exercise with acute and chronic high altitude exposure.
Am J Physiol.
1991;
261
E419-E424
M. Basu
Defence Institute of Physiology and Allied Sciences ·
Lucknow Road, Timarpur · Delhi - 110 054 · India ·
Phone: + 91 (11) 394 6546
Fax: + 91 (11) 393 2869
Email: em_dipas@yahoo.com
