Schade D S, Eaton R P, Standefer J
J Clin Endocrinol Metab. 1978 Sep;47(3):519-28. doi: 10.1210/jcem-47-3-519.
This study explored the relationship between metyrapone blockade of endogenous cortisol secretion and the plasma concentration of basal ketone bodies in insulin-dependent diabetic man. Endogenous cortisol secretion was reduced with metyrapone administration (as assessed by a reduction in plasma cortisol and an increase in deoxycortisol concentration) and then simulated with two different schedules of exogenous cortisol administration. Our results demonstrate that administration of metyrapone suppresses plasma cortisol concentration which may then be elevated by the oral ingestion of cortisol. The suppression of endogenous cortisol secretion with metyrapone results in a 50% reduction in basal plasma ketone body concentration. When endogenous cortisol secretion was simulated with the oral administration of 30 mg cortisol, plasma ketone body concentration returned to that concentration observed in the control study. When 60 mg cortisol were administered in divided dosages to the diabetic subjects, hyperketonemia resulted. These results suggest that the normal diurnal variation in plasma cortisol concentration may modulate the basal plasma ketone body concentration in diabetic man. The mechanism of this modulation may be a direct effect of cortisol or may be secondary to cortisol's lipolytic activity and/or its effects on elevating plasma glucagon concentration.
本研究探讨了美替拉酮对内源性皮质醇分泌的阻断作用与胰岛素依赖型糖尿病男性患者血浆基础酮体浓度之间的关系。给予美替拉酮后内源性皮质醇分泌减少（通过血浆皮质醇降低和脱氧皮质醇浓度升高来评估），然后用两种不同的外源性皮质醇给药方案进行模拟。我们的结果表明，给予美替拉酮可抑制血浆皮质醇浓度，随后口服皮质醇可使其升高。美替拉酮对内源性皮质醇分泌的抑制导致基础血浆酮体浓度降低50%。当口服30mg皮质醇模拟内源性皮质醇分泌时，血浆酮体浓度恢复到对照研究中观察到的浓度。当向糖尿病受试者分剂量给予60mg皮质醇时，会导致高酮血症。这些结果表明，血浆皮质醇浓度的正常昼夜变化可能调节糖尿病男性患者的基础血浆酮体浓度。这种调节机制可能是皮质醇的直接作用，也可能继发于皮质醇的脂解活性和/或其对升高血浆胰高血糖素浓度的作用。
