Stress dose of hydrocortisone is not beneficial in patients with classic congenital adrenal hyperplasia undergoing short-term, high-intensity exercise.
Level 2 - randomized trial
Randomized, double-blind, placebo-controlled crossover trial
PubMed 15292287 · doi:10.1210/jc.2003-032051
What was done
Nine adolescent patients with classic congenital adrenal hyperplasia (CAH) were evaluated during a standardized high-intensity exercise protocol. Using a randomized, double-blind, crossover design, participants received either an extra morning dose of hydrocortisone or placebo 1 hour before exercise, in addition to their standard glucocorticoid and mineralocorticoid replacement therapy. Hormonal, metabolic, and cardiorespiratory responses were measured.
What was found
The extra hydrocortisone dose approximately doubled plasma cortisol levels compared with the standard single dose. However, fasting and exercise-induced blood glucose concentrations did not differ between the hydrocortisone and placebo conditions. There were also no differences in levels of epinephrine, insulin, glucagon, growth hormone, lactate, or free fatty acids. Maximal heart rate was slightly higher with hydrocortisone (193 ± 3 vs. 191 ± 3 beats/min, P < 0.05), but exercise performance and perceived exertion did not differ.
Why it matters
Pre-exercise stress dosing with hydrocortisone is unnecessary for short-term high-intensity exertion in classic CAH and fails to correct blunted glycemic responses. Avoiding routine extra dosing prevents unnecessary glucocorticoid overexposure in these patients.
Limits
The sample size was very small (n = 9), and the study was restricted to adolescents with classic CAH. It only evaluated short-term, high-intensity exercise, so findings cannot be generalized to prolonged or endurance exercise. Numeric values for glucose and other hormones were not reported in the abstract.
Cited by
- supports High-intensity interval training (HIIT) can raise blood glucose to 120-140 mg/dL in fat-adapted individuals through cortisol and epinephrine secretion.