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Tavares ABW, Seixas-da-Silva IA, Silvestre DHS, Pinheiro MFC, Vaisman M, Conceição FL. Growth hormone and cortisol secretion in the elderly evaluated using the glucagon stimulation test. Endocrine 2017; 56:317-324. [PMID: 28285384 DOI: 10.1007/s12020-017-1275-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The glucagon stimulation test is a reliable alternative test to assess growth hormone and cortisol secretion, but has not been widely used in the elderly population. The aim of this study was to evaluate growth hormone and cortisol secretion using the glucagon stimulation test in an elderly population without known hypothalamic-pituitary disease and to correlate growth hormone and cortisol peaks with age (less than or greater than 80 years) and body mass index. METHODS Forty-two subjects (67-88 years) from the geriatric ambulatory unit were submitted and 41 subjects completed the glucagon stimulation test. RESULTS Median growth hormone peak was 5.99 μg/L and median cortisol peak was 21.6 μg/dL. Growth hormone peak was >3 µg/L in 73.2%, and cortisol peak was >18 µg/dL in 65.8% of patients. There was a statistically significant positive correlation between the growth hormone peak and the cortisol peak. The cortisol peak was significantly different between subjects stratified by growth hormone peak of < or >3 μg/L (15.7 and 21.8 μg/dL, respectively). There was a statistically significant difference in cortisol peak according to age < or > 80 years (22.4 and 18.5 µg/dL, respectively). Considering lower cut-offs recently proposed for growth hormone peak (1.0 μg/L for overweight subjects) and cortisol peak (9.1 μg/dL), only two patients had a growth hormone peak below this value, and all patients had preserved cortisol secretion. CONCLUSIONS We did find a positive correlation between growth hormone and cortisol peaks in the glucagon stimulation test in the elderly, confirming the capacity of the glucagon stimulation test to stimulate both axes. According to the new proposed cut-points for growth hormone and cortisol, we had 95% of normal growth hormone and 100% of normal cortisol responses.
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Affiliation(s)
- Ana Beatriz Winter Tavares
- Division of Endocrinology - Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Ignácio Antônio Seixas-da-Silva
- Division of Endocrinology - Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diego H S Silvestre
- Division of Endocrinology - Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Mario Vaisman
- Division of Endocrinology - Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flávia Lucia Conceição
- Division of Endocrinology - Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Ignacio DL, Silvestre DHS, Anne-Palmer E, Bocco BMLC, Fonseca TL, Ribeiro MO, Gereben B, Bianco AC, Werneck-de-Castro JP. Early Developmental Disruption of Type 2 Deiodinase Pathway in Mouse Skeletal Muscle Does Not Impair Muscle Function. Thyroid 2017; 27:577-586. [PMID: 27967605 PMCID: PMC5385430 DOI: 10.1089/thy.2016.0392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Myogenesis is positively regulated by thyroid hormone (triiodothyronine [T3]), which is amplified by the type 2 deiodinase (D2) activation of thyroxine to T3. Global inactivation of the Dio2 gene impairs skeletal muscle (SKM) differentiation and regeneration in response to muscle injury. Given that newborn and adult mice with late developmental SKM Dio2 disruption do not develop a significant phenotype, it was hypothesized that D2 plays an early role in this process. METHODS This was tested in mice with SKM disruption of Dio2 driven by two early developmental promoters: MYF5 and MYOD. RESULTS MYF5 myoblasts in culture differentiate normally into myotubes, despite loss of almost all D2 activity. Dio2 mRNA levels in developing SKM obtained from MYF5-D2KO embryos (E18.5) were about 54% of control littermates, but the expression of the T3-responsive genes Myh1 and 7 and Atp2a1 and 2 were not affected. In MYF5-D2KO and MYOD-D2KO neonatal hind-limb muscle, the expression of Myh1 and 7 and Atp2a2 remained unaffected, despite 60-70% loss in D2 activity and/or mRNA. Only in MYOD-D2KO neonatal muscle was there a 40% reduction in Atp2a1 mRNA. Postnatal growth of both mouse models and SKM function as assessed by exercise capacity and measurement of muscle strength were normal. Furthermore, an analysis of the adult soleus revealed no changes in the expression of T3-responsive genes, except for an about 18% increase in MYOD-D2KO SOL Myh7 mRNA. CONCLUSION Two mouse models of early developmental disruption of Dio2 in myocyte precursor exhibit no significant SKM phenotype.
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Affiliation(s)
- Daniele L Ignacio
- 1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois
- 2 Biophysics Institute and School of Physical Education and Sports, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Diego H S Silvestre
- 1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois
- 2 Biophysics Institute and School of Physical Education and Sports, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
- 3 Nutrition Institute Josué de Castro, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Elena Anne-Palmer
- 1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois
| | - Barbara M L C Bocco
- 1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois
- 4 Department of Translational Medicine, Federal University of São Paulo , São Paulo, Brazil
| | - Tatiana L Fonseca
- 1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois
| | - Miriam O Ribeiro
- 5 Developmental Disorders Program, Center for Biological and Health Sciences, Mackenzie Presbyterian University , São Paulo, Brazil
| | - Balázs Gereben
- 6 Department of Endocrine Neurobiology, Institute of Experimental Medicine , Hungarian Academy of Sciences, Budapest, Hungary
| | - Antonio C Bianco
- 1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois
| | - Joao P Werneck-de-Castro
- 1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois
- 2 Biophysics Institute and School of Physical Education and Sports, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
- 3 Nutrition Institute Josué de Castro, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
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Bocco BMLC, Louzada RAN, Silvestre DHS, Santos MCS, Anne-Palmer E, Rangel IF, Abdalla S, Ferreira AC, Ribeiro MO, Gereben B, Carvalho DP, Bianco AC, Werneck-de-Castro JP. Thyroid hormone activation by type 2 deiodinase mediates exercise-induced peroxisome proliferator-activated receptor-γ coactivator-1α expression in skeletal muscle. J Physiol 2016; 594:5255-69. [PMID: 27302464 PMCID: PMC5023700 DOI: 10.1113/jp272440] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/30/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS In skeletal muscle, physical exercise and thyroid hormone mediate the peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1a) expression that is crucial to skeletal muscle mitochondrial function. The expression of type 2 deiodinase (D2), which activates thyroid hormone in skeletal muscle is upregulated by acute treadmill exercise through a β-adrenergic receptor-dependent mechanism. Pharmacological block of D2 or disruption of the Dio2 gene in skeletal muscle fibres impaired acute exercise-induced PGC-1a expression. Dio2 disruption also impaired muscle PGC-1a expression and mitochondrial citrate synthase activity in chronically exercised mice. ABSTRACT Thyroid hormone promotes expression of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1a), which mediates mitochondrial biogenesis and oxidative capacity in skeletal muscle (SKM). Skeletal myocytes express the type 2 deiodinase (D2), which generates 3,5,3'-triiodothyronine (T3 ), the active thyroid hormone. To test whether D2-generated T3 plays a role in exercise-induced PGC-1a expression, male rats and mice with SKM-specific Dio2 inactivation (SKM-D2KO or MYF5-D2KO) were studied. An acute treadmill exercise session (20 min at 70-75% of maximal aerobic capacity) increased D2 expression/activity (1.5- to 2.7-fold) as well as PGC-1a mRNA levels (1.5- to 5-fold) in rat soleus muscle and white gastrocnemius muscle and in mouse soleus muscle, which was prevented by pretreatment with 1 mg (100 g body weight)(-1) propranolol or 6 mg (100 g body weight)(-1) iopanoic acid (5.9- vs. 2.8-fold; P < 0.05), which blocks D2 activity . In the SKM-D2KO mice, acute treadmill exercise failed to induce PGC-1a fully in soleus muscle (1.9- vs. 2.8-fold; P < 0.05), and in primary SKM-D2KO myocytes there was only a limited PGC-1a response to 1 μm forskolin (2.2- vs. 1.3-fold; P < 0.05). Chronic exercise training (6 weeks) increased soleus muscle PGC-1a mRNA levels (∼25%) and the mitochondrial enzyme citrate synthase (∼20%). In contrast, PGC-1a expression did not change and citrate synthase decreased by ∼30% in SKM-D2KO mice. The soleus muscle PGC-1a response to chronic exercise was also blunted in MYF5-D2KO mice. In conclusion, acute treadmill exercise increases SKM D2 expression through a β-adrenergic receptor-dependent mechanism. The accelerated conversion of T4 to T3 within myocytes mediates part of the PGC-1a induction by treadmill exercise and its downstream effects on mitochondrial function.
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Affiliation(s)
- Barbara M L C Bocco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA
- Department of Translational Medicine, Federal University of São Paulo, Brazil
| | - Ruy A N Louzada
- Institute of Biophysics Carlos Chagas Filho and School of Physical Education and Sports, Federal University of Rio de Janeiro, Brazil
| | - Diego H S Silvestre
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA
- Institute of Biophysics Carlos Chagas Filho and School of Physical Education and Sports, Federal University of Rio de Janeiro, Brazil
| | - Maria C S Santos
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Brazil
| | - Elena Anne-Palmer
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA
| | - Igor F Rangel
- Institute of Biophysics Carlos Chagas Filho and School of Physical Education and Sports, Federal University of Rio de Janeiro, Brazil
| | - Sherine Abdalla
- Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea C Ferreira
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Brazil
| | - Miriam O Ribeiro
- Developmental Disorders Program, Center for Biological and Health Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - Balázs Gereben
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Denise P Carvalho
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Brazil
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA
| | - João P Werneck-de-Castro
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA.
- Institute of Biophysics Carlos Chagas Filho and School of Physical Education and Sports, Federal University of Rio de Janeiro, Brazil.
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Tavares ABW, Seixas-da-Silva IA, Silvestre DHS, Paixão CM, Vaisman M, Conceição FL. Potential risks of glucagon stimulation test in elderly people. Growth Horm IGF Res 2015; 25:53-56. [PMID: 25481820 DOI: 10.1016/j.ghir.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED The glucagon stimulation test (GST) is a reliable measure for assessing growth hormone (GH) and adrenocorticotropic hormone (ACTH) secretion. The GST is considered to be a safe test, with few mild side effects, especially in adults and in the elderly in whom underlying co-morbidities may be present. OBJECTIVE To describe the side effects of the GST in elderly people. DESIGN AND SETTING The study was performed with patients of the geriatric ambulatory of our hospital who were recruited to voluntarily participate in a research study concerning the GH and ACTH axis in the elderly people. Forty-two subjects (n=5 males and 37 females) aged 67-88 years, without hypothalamic-pituitary disease, were submitted to the GST. The GST was performed by intramuscular injection of 1mg of glucagon. Blood samples were collected at baseline, and 90, 120, 150, and 180 min after glucagon injection for GH and cortisol measurements. RESULTS During the test, 9 subjects (21.4%) had side effects, which included: nausea (14.2%), indisposition (11.9%), hypotension (9.5%), vomiting (7.1%), sweating (4.7%), and dizziness (2.3%). There were four cases of severe symptomatic hypotension, with inaudible blood pressure in two cases. In one case of severe hypotension, the subject suffered two episodes of generalized tonic seizures. Patients who had side effects at GST had statistically higher peak of cortisol (28.9 ± 6.67 μg/dL) and a statistical trend to higher GH peak (8.74 ± 5.96 μg/L). In the group of patients who did not have side effects, the mean cortisol and GH peak were 19.05 ± 5.36 μg/dL and 5.32 ± 3.52 μg/L, respectively. CONCLUSION Although the GST is a reliable alternative test to the ITT, it should be cautiously used in the elderly because this population may have co-morbidities including vascular and cardiac diseases that could be potentiated with side effects of the test, such as severe hypotension.
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Affiliation(s)
- Ana Beatriz Winter Tavares
- Division of Endocrinology, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Ignácio Antônio Seixas-da-Silva
- Division of Endocrinology, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diego H S Silvestre
- Division of Endocrinology, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carlos Montes Paixão
- Division of Geriatric Medicine, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mario Vaisman
- Division of Endocrinology, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flávia Lucia Conceição
- Division of Endocrinology, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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