Cortisol Levels in Protein-calorie Malnutrition

The two clinical syndromes of protein-calorie malnutrition-kwashiorkor and marasmus, have been widely studied. Striking differences have been observed between kwashiorkor and marasmus, both with respect to the clinical picture and the biochemical profile. One such difference is the exaggerated hyperglycaemic response of the marasmic infant to epinephrine in contrast to the poor response of the child with kwashiorkor (Rao, 1965). The role of the adrenal cortex in determining the full response to epinephrine has been demonstrated by Shafrir and Steinberg (1960). It is possible that some other differences between kwashiorkor and marasmus may also be ascribed to variations in the adrenocortical activity in these two conditions. Indirect evidence for this has been obtained in preliminary studies by the authors, where the development of fatty livers in monkeys maintained on protein-free diets has been appreciably delayed by the simultaneous administration of hydrocortisone. Available data regarding adrenocortical function in protein-calorie malnutrition are conflicting. Ramachandran, Venkatachalam, and Gopalan (1956) observed lowered urinary excretion of 17-ketosteroids in kwashiorkor. Lurie and Jackson (1962) concluded, on the basis of urinary excretion of 17-hydroxycorticosteroids, that adrenocortical function was not impaired in kwashiorkor; they considered that estimation of urinary 17-ketosteroids was a poor assessment of adrenal function. Plasma cortisol concentration has been claimed to be a better index of adrenocortical function (Bayliss, 1955). In this paper, the results of an investigation of plasma cortisol levels in kwashiorkor and marasrmus are presented.