Cortisol Metabolism and the Pituitary-Adrenal Axis in Adults with Protein-Calorie Malnutrition

Cortisol metabolism and the pituitaryadrenal axis were investigated in 10 adult patients with protein-calorie malnutrition in Calcutta, India. Control studies were performed on all patients after complete recovery. Plasma cortisol was elevated in malnutrition, and urinary cortisol was high in relation to creatinine clearance. Metabolic clearance rateand plasma production rate were reduced, andurinary 17-hydroxycorticosteroid excretion was reduced to a greater degree than cortisol production. Plasma ACTH was maintained, in spite of the elevated plasma cortisol. Testing with ACTH and metyrapone produced appropriate adrenal and pituitary responses. Dexamethasone administration failed to suppress plasma cortisol to a normal degree. Dextrose infusion produced similar decreases in plasma cortisol in malnutrition and after refeeding. It is concluded that cortisol metabolism is reduced in rate in protein-calorie malnutrition and is altered such that production of the chloroform-extractable 17-hydroxycorticosteroi...