Relationships between the pituitary-adrenal hormones, insulin, and glucosein middle-aged men: Moderating influence of psychosocial stress

We examined whether the relationships between the pituitary-adrenal hormone s (corticotropin [ACTH] and cortisol), insulin, and glucose differ as a fun ction of psychosocial stress defined in terms of vital exhaustion NEI and d epressive behavior (DB). The participants were 69 normotensive and 21 unmed icated borderline hypertensive (BH) middle-aged men whose work is stressful . Hormonal and metabolic variables were measured during an oral glucose tol erance test (OGTT), and the cortisol response to dexamethasone (DXM) suppre ssion and intravenous ACTH stimulation was also measured. We found that the basal ACTH level during the OGTT was positively associated with the cortis ol response to ACTH at 60 minutes, the fasting insulin level, and the insul in to glucose ratio among exhausted and high DB men, while the reverse was true for nonexhausted and low DB men. Also, a high cortisol response to ACT H, a low cortisol level during the OGTT, and a high ratio of these cortisol determinations (corrisol ratio) were associated with high fasting insulin and glucose levels, the summed insulin values, and the insulin to glucose r atio only among nonexhausted and low DB men; among exhausted and high DB me n, these associations were less pronounced, absent, or in the opposite dire ction. The findings suggest that VE and DB have a moderating influence on t he relationships among the hormonal and metabolic parameters studied. Psych osocial stress may affect the pituitary-adrenocortical system in complex wa ys, contributing thereby to insulin resistance, hyperinsulinemia, and coron ary heart disease (CHD) risk. Copyrigh (C) 1998 by W.B. Saunders Company.