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Erschienen in: Endocrine 2/2020

20.06.2020 | Original Article

Pituitary-adrenal axis and peripheral cortisol metabolism in obese patients

verfasst von: Filippo Ceccato, Laura Lizzul, Mattia Barbot, Carla Scaroni

Erschienen in: Endocrine | Ausgabe 2/2020

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Abstract

Background and aim

A close relationship between adiposity and increased cortisol levels is well established in patients with endogenous hypercortisolism. Nevertheless, hypothalamic-pituitary-adrenal (HPA) axis regulation in overweight subjects is still a matter of concern. We studied free cortisol (urinary free cortisol, UFC and late night salivary cortisol, LNSC), pituitary feedback (serum cortisol after 1 mg dexamethasone suppression test, 1 mg DST) and peripheral cortisol metabolism (urinary cortisol to cortisone ratio, F/Eratio) in a large series of overweight subjects without Cushing’s Syndrome.

Materials and methods

We considered 234 patients divided in 5 BMI classes, matched for age and gender (BMI ≤ 25 kg/m2n = 38; 25–30 n = 58; 30–35 n = 52; 35–40 n = 52; >40 n = 34). UFC, LNSC and urinary F/Eratio were assessed with LC-MS.

Results

We collected 183 LNSC, 176 UFC, 152 1 mg DST and 64 F/Eratio tests. UFC levels were higher in lean subjects, and they decreased according to the BMI classes (p = 0.022). Non-suppressed cortisol levels (>50 nmol/L) after 1 mg DST were observed especially in patients with normal weight or mild obesity. Patients with BMI ≥ 35 kg/m2 revealed a reduced F/Eratio (0.39 vs. 0.61, p = 0.006). The specificity of tests (false positive results) was higher considering 1 mg DST or UFC in obese patients, on the contrary impaired cortisol rhythm (LNSC above normality) was observed in 47 subjects, irrespective of weight.

Conclusions

Overweight and obese subjects are characterised by an original regulation of HPA axis (reduced UFC levels, increased suppression after 1 mg DST) and peripheral cortisol metabolism (reduced F/Eratio), suggesting an effort to counteract hypercortisolism.
Literatur
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Zurück zum Zitat F. Ceccato, G. Antonelli, M. Barbot et al. The diagnostic performance of urinary free cortisol is better than the cortisol: cortisone ratio in detecting de novo Cushing’s Syndrome: The use of a LC-MS/MS method in routine clinical practice. Eur. J. Endocrinol. 171(1) (2014). https://​doi.​org/​10.​1530/​EJE-14-0061 F. Ceccato, G. Antonelli, M. Barbot et al. The diagnostic performance of urinary free cortisol is better than the cortisol: cortisone ratio in detecting de novo Cushing’s Syndrome: The use of a LC-MS/MS method in routine clinical practice. Eur. J. Endocrinol. 171(1) (2014). https://​doi.​org/​10.​1530/​EJE-14-0061
Metadaten
Titel
Pituitary-adrenal axis and peripheral cortisol metabolism in obese patients
verfasst von
Filippo Ceccato
Laura Lizzul
Mattia Barbot
Carla Scaroni
Publikationsdatum
20.06.2020
Verlag
Springer US
Erschienen in
Endocrine / Ausgabe 2/2020
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-020-02392-4

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