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Relation of Adrenal Androgen to Insulin Levels
- John E. Nestler, MD
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TO THE EDITOR:
The report by Barrett-Connor [1] that serum levels of the adrenal androgens dehydroepiandrosterone (DHEA) and DHEA-sulfate are decreased in untreated men with mild type II diabetes mellitus is thought provoking. During the past decade, it has become apparent that insulin may act as a physiologic regulator of human steroid hormone biosynthesis [2]. Although serum insulin levels were not reported in Barrett-Connor's study [1], it seems likely that the untreated men with type II diabetes mellitus were insulin resistant and hyperinsulinemic.
Insulin has been shown to lower acutely serum DHEA and DHEA-sulfate levels in men and women [2]. Conversely, amelioration of insulin resistance and hyperinsulinemia in obese insulin-resistant men, who otherwise manifest normal glucose tolerance, has resulted in a dramatic rise in serum DHEA-sulfate levels [3]. It would have been interesting to assess whether an inverse correlation existed between fasting serum insulin and adrenal androgen levels in these men.
The possible regulation of adrenal androgens by insulin is all the more intriguing because of recent evidence, including that of Barrett-Connor and colleagues [4], which suggests that DHEA exerts several potent antiatherogenic and cardioprotective actions [5]. An insulin-mediated reduction in circulating DHEA and DHEA-sulfate may serve as a mechanism for the well-described epidemiologic association between hyperinsulinemic states (such as type II diabetes mellitus, obesity, and aging) and atherosclerosis [5].
It would be most instructive if Barrett-Connor and colleagues measured serum adrenal androgen levels in these diabetic men after instituting either dietary or long-term oral hypoglycemic therapy. If insulin sensitivity were enhanced and reduction in circulating insulin were reduced, serum DHEA and DHEA-sulfate levels might concurrently rise.
John E. Nestler
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
