5ɑ-reductase and adrenal insufficiency

Patients with critical illness or hepatic failure exhibit impaired cortisol response to ACTH, or ‘relative adrenal insufficiency’. The mechanism could be that elevated bile acids inhibit inactivation of cortisol in liver by 5α-reductases, leading to downregulation of the hypothalamic–pituitary–adrenal axis and adrenocortical atrophy. Livingstone and colleagues investigated the consequences of 5α-reductase type 1 deficiency in mice. Their results confirm that impaired peripheral clearance of glucocorticoids can cause ‘relative adrenal insufficiency’ in mice, an observation with important implications for patients with critical illness or hepatic failure, and for patients receiving 5α-reductase inhibitors for prostatic disease.

Read the full article at Livingstone et al. (2014) Journal of Endocrinology 222 257–266; DOI:10.1530/JOE-13-0563