Reduced Cortisol and Iron Deficiency

Topic - Reduced Cortisol and Iron Deficiency
Essence of the Article:
When looking at either cortisol, iron or both, consider that there may be a relationship between them.  Iron deficient states may contribute to decreased cortisol production. 
Essential Thinking: Before beginning iron therapy, consider checking TIBC to be sure binding protein is adequate.  It is generally unwise to commence iron therapy during an infection.  Ferritin is an acute phase reactant which lowers serum iron that can benefit pathogens.
Also consider gluconate or glycinate rather than sulfate forms of iron.
Ann Nutr Metab. 1991;35(2):111-5.
Reduced cortisol secretion in patients with iron deficiency.
Saad MJ, Morais SL, Saad ST.

Department of Clinical Medicine, UNICAMP, State University of Campinas, Brazil.

The iron-containing protein cytochrome P-450 is present in high concentration in the adrenal cortex and is involved in the synthesis of corticosterone. This study was designed to determine the cortisol response to adrenocorticotropin (ACTH) in patients with severe iron deficiency. Eleven patients with iron deficiency and 15 normal controls were studied. Fasting blood samples were taken from all the subjects before and 30, 60 and 120 min after infusion of 25 units of ACTH for plasma cortisol determination. Six patients had blood samples collected at night, too. The same test was performed in 6 patients with iron deficiency, 7 days after therapy with 800 mg of ferrous sulfate. No significant differences were observed between patients and controls for the baseline cortisol values. The cortisol secretion and the increment at 30, 60 and 120 min after ACTH infusion were significantly lower in patients than in controls, either before or after ferrous sulfate therapy. There were no significant differences between baseline and stimulated cortisol values in patients before and after 7 days of ferrous sulfate therapy. There was no change in cortisol secretion rhythm in patients with iron deficiency (cortisol level at night = 5.1 +/- 4.3 micrograms/dl). In conclusion, the results of the present study showed that, in patients with severe iron deficiency, the cortisol secretion after ACTH stimulation was decreased.
[PubMed - indexed for MEDLINE]
Differential Consideration
Postgrad Med. 1992 Sep 15;92(4):123-8.
Iron deficiency and anemia of chronic disease. Clues to differentiating these conditions.
Mohler ER Jr.

Department of Internal Medicine, St Agnes Hospital, Baltimore.

Iron deficiency occurs when the body's iron stores are exhausted. The source of blood loss leading to iron deficiency must be identified in all cases. Anemia of chronic disease generally results from an infectious, inflammatory, or malignant process. However, in some reported cases, no such process could be identified. Differentiating iron deficiency anemia from anemia of chronic disease may be difficult because of similarities in presentation. Physicians need to be aware of special clinical considerations when these two types of anemia coexist. Ferrous sulfate therapy is the ideal form of iron replacement.
[PubMed - indexed for MEDLINE]