Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

CONTEXT: Glucocorticoids (GC) are commonly prescribed, but their use is associated with adverse metabolic effects. 5a-reductase inhibitors (5aRI) are also frequently prescribed, mainly to inhibit testosterone conversion to dihydrotestosterone. However, they also prevent the inactivation of GCs. OBJECTIVE: We hypothesised that 5aRIs may worsen the adverse effects of GCs. DESIGN: Prospective, randomised study. PATIENTS: 19 healthy male volunteers (age; 45±2 years, BMI; 27.1±0.7kg/m2). INTERVENTIONS: Participants underwent metabolic assessments; 2-step hyperinsulinemic, euglycemic clamp incorporating stable-isotopes, adipose tissue microdialysis and biopsy. Participants were then randomised to either prednisolone (10mg daily) or prednisolone (10mg daily) plus a 5aRI (finasteride 5mg daily or dutasteride 0.5mg daily) for 7 days; metabolic assessments were then repeated. MAIN OUTCOME MEASURES: Ra glucose, glucose utilization (M-value), glucose oxidation, non-esterified fatty acids (NEFA) levels. RESULTS: Co-administration of prednisolone with a 5aRI increased circulating prednisolone levels (482±96 vs. 761±57nmol/L, p=0.029). Prednisolone alone did not alter Ra glucose (2.55±0.34 vs 2.62±0.19mg/kg/min, p=0.86), M-value (3.2±0.5 vs 2.7±0.7mg/kg/min, p=0.37), or glucose oxidation (0.042±0.007 vs 0.040±0.004mmol/hr/kg/min, p=0.79). However, co-administration with a 5aRI increased Ra glucose (2.67±0.16 vs. 3.05±0.18mg/kg/min, p<0.05) and decreased M-value (4.0±0.5 vs. 2.6±0.4mg/kg/min, p<0.05), and oxidation (0.043±0.003 vs. 0.036±0.002mmol/hr/kg, p<0.01). Similarly, prednisolone did not impair insulin-mediated suppression of circulating NEFA (43.1±28.9 vs. 36.8±14.3μmol/L, p=0.81), unless co-administered with a 5aRI (49.8±8.6 vs. 88.5±13.5μmol/L, p<0.01). CONCLUSIONS: We have demonstrated that 5aRIs exacerbate the adverse effects of prednisolone. This study has significant translational implications, including the need to consider GC dose adjustments, but also the necessity for increased vigilance for the development of adverse effects.

Original publication

DOI

10.1210/clinem/dgaa408

Type

Journal article

Journal

J Clin Endocrinol Metab

Publication Date

27/06/2020

Keywords

Dutasteride, Finasteride, Prednisolone, hyperinsulinemic euglycemic clamp, insulin