Adrenocorticosteroids and corticosteroid binding globulins in protein calorie malnutrition

A study of adrenocorticosteroids and corticosteroid binding globulins was undertaken in 35 malnourished children with a weight deficit of 10 to 45%. The mean corticosteroid levels 5.9 +/- 3.0 mug% were not significantly different from control values of 6.43 +/- 3.2 mug%. Steroid levels were however low (4.38 +/- 1.8 mug%) in children with marasmic kwashiorkor. The corticosteroid binding globulin was reduced to 11.9 +/- 5.4 mug of cortisol bound in malnourished children with and without edema and was significantly lower than controls. "Free cortisol" levels were significantly raised in the malnourished state. In the presence of acute infection there was a remarkable rise of steroids suggesting that there was no hypofunction of the adrenal cortex. Where the infection was chronic (e.g., pulmonary tuberculosis) the levels were normal suggesting an adaptation to the stress. Early studies of the steroids and corticosteroid binding globulins within 2 to 3 weeks of starting a high protein diet showed that there was a remarkable rise of serum albumin 2.3 +/- 0.4 to 3.3 +/- 0.7 g%, steroids from 5.9 +/- 5.5 to 12.3 +/- 7.4 and corticosteroid binding globulins from 13.0 +/- 4.1 to 20.2 +/- 6.3 mug of cortisol bound per 100 ml. Weight gain was from 0.2 to 1.0 kg. A follow-up of four children for 6 weeks showed that the steroid levels fell to within normal limits. The integrity of the hypothalamohypophyseal adrenal axis was unimpaired in five out of six children studied. In conclusion it appears that marasmic children are well adapted to the stress of malnutrition and the ability of the adrenals to respond to stress is unimpaired.