ALTERATIONS IN CORTISOL METABOLISM IN IDDM PATIENTS ...

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resulted in a moderate further lowering of the cortisol to cortisone metabolite ...... reductase deficiency and some consequences for corticosteroid metabolism.
CHAPTER 11 ALTERATIONS IN CORTISOL METABOLISM IN IDDM PATIENTS: RELATIONSHIP WITH METABOLIC CONTROL AND ESTIMATED BLOOD VOLUME AND EFFECT OF ANGIOTENSIN CONVERTING ENZYME-INHIBITION R.P.F. Dullaart1, F.L. Ubels2, K. Hoogenberg1, A.J. Smit2, J.J. Pratt5, J.H.J. Muntinga3, W.J. Sluiter1 and B.G. Wolthers4 11ß-hydroxysteroid dehydrogenase (11ß-HSD) catalyses the interconversion of cortisol and its inactive metabolite, cortisone, and protects the mineralocorticoid receptor from activation by cortisol. Sodium and fluid retention is a well documented phenomenon in IDDM patients, but it is unknown whether alterations in cortisol metabolism contribute to its pathogenesis. Therefore, we evaluated some aspects of cortisol metabolism by measuring urinary metabolites of cortisol and cortisone in 8 microalbuminuric and 8 normoalbuminuric IDDM patients and 8 matched control subjects. In both IDDM groups, the overnight excretion of tetrahydrocortisol (THF), allo-tetrahydrocortisol (allo-THF) and tetrahydrocortisone (THE) was lower than in the control group (p20 µg/min in each micro-albuminuric patient and