Altered cortisol metabolism in individuals with HNF1A-MODY

Agata Juszczak, Lorna Gilligan, Beverly Hughes, Zaki Hassan-Smith, Mark I McCarthy, Wiebke Arlt, Jeremy Tomlinson, Katharine R. Owen

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Objective and context: Maturity onset diabetes of the young due to variants in HNF1A (HNF1A‐MODY) is the most common form of monogenic diabetes. Individuals with HNF1A‐MODY usually have a lean phenotype which contrasts with type 2 diabetes (T2DM). Data from hepatocytes derived from Hnf1a knock‐out mice demonstrated dysregulation of 11β‐hydroxysteroid dehydrogenase type 1 (11β‐HSD1), which regulates glucocorticoid availability and action in target tissues, together with 11β‐HSD2 and steroid A‐ring reductases, 5α‐ and 5β‐reductase. We proposed that altered glucocorticoid metabolism might underpin some of the phenotypic differences between patients with HNF1A‐MODY and those with T2DM.

Design: A retrospective matched cohort study.

Patients and measurements: 24‐hours urine steroid metabolome profiling was carried out by gas chromatography‐mass spectrometry in 35 subjects with HNF1A‐MODY, 35 individuals with T2DM and 35 healthy controls matched for age, sex and BMI. The steroid metabolites were expressed as μg/L in all groups and measured in mid‐morning urine in diabetic subjects and 24‐hour urine collection in healthy controls. Hence, only ratios were compared not the individual steroids. Established ratios of glucocorticoid metabolites were used to estimate 11β‐HSD1/2 and 5α‐ and 5β‐reductase activities.

Results: While 11β‐HSD1 activity was similar in all groups, 11β‐HSD2 activity was significantly lower in subjects with HNF1A‐MODY and T2DM than in healthy controls. The ratio of 5β‐ to 5α‐metabolites of cortisol was higher in subjects with HNF1A‐MODY than in T2DM and healthy controls, probably due to increased activity of the 5β‐reductase (AKR1D1) in HNF1A‐MODY.

Conclusions: This is the first report of steroid metabolites in HNF1A‐MODY. We have identified distinct differences in steroid metabolism pathways in subjects with HNF1A‐MODY that have the potential to alter steroid hormone availability. Further studies are required to explore whether these changes link to phenotype.
Original languageEnglish
Pages (from-to)269-279
JournalClinical Endocrinology
Issue number3
Early online date12 May 2020
Publication statusE-pub ahead of print - 12 May 2020


  • HNF1A
  • MODY
  • urinary steroids


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