Current challenges and future directions in the assessment of glucocorticoid status
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Glucocorticoid (GC) hormones are secreted in a circadian and ultradian rhythm and play a critical role in maintaining physiological homeostasis, with both excess and insufficient GC associated with adverse effects on health. Current assessment of GC status is primarily clinical, often in conjunction with serum cortisol values, which may be stimulated or suppressed depending on the GC disturbance being assessed. In the setting of extreme perturbations in cortisol levels ie, markedly low or high levels, symptoms and signs of GC dysfunction may be overt. However, when disturbances in cortisol GC status values are less extreme, such as when assessing optimization of a GC replacement regimen, signs and symptoms can be more subtle or nonspecific. Current tools for assessing GC status are best suited to identifying profound disturbances but may lack sensitivity for confirming optimal GC status. Moreover, single cortisol values do not necessarily reflect an individual's GC status, as they are subject to inter- and intraindividual variation and do not take into account the pulsatile nature of cortisol secretion, variation in binding proteins, or local tissue concentrations as dictated by 11beta-hydroxysteroid dehydrogenase activity, as well as GC receptor sensitivity. In the present review, we evaluate possible alternative methods for the assessment of GC status that do not solely rely on the measurement of circulating cortisol levels. We discuss the potential of changes in metabolomic profiles, micro RNA, gene expression, and epigenetic and other novel biomarkers such as growth differentiating factor 15 and osteocalcin, which could in the future aid in the objective classification of GC status.
Date Issued
2024-12-01
Date Acceptance
2024-05-01
Citation
Endocrine Reviews, 2024, 45 (6), pp.795-817
ISSN
0163-769X
Publisher
Oxford University Press
Start Page
795
End Page
817
Journal / Book Title
Endocrine Reviews
Volume
45
Issue
6
Copyright Statement
© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. See the journal About page for additional terms.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/38795365
PII: 7682328
Subjects
11-BETA-HYDROXYSTEROID DEHYDROGENASE TYPE-1
Addison's disease
adrenal
CORTICOSTEROID-BINDING GLOBULIN
DEXAMETHASONE-SUPPRESSION TEST
Endocrinology & Metabolism
glucocorticoid
GROWTH-FACTOR-I
INDUCED INSULIN-RESISTANCE
Life Sciences & Biomedicine
MENSTRUAL-CYCLE PHASE
pituitary gland
PLASMA-FREE CORTISOL
PRIMARY ADRENAL INSUFFICIENCY
Science & Technology
steroids
TANDEM MASS-SPECTROMETRY
URINARY FREE CORTISOL
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2024-05-25