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Bavaresco A, Mazzeo P, Lazzara M, Barbot M. Adipose tissue in cortisol excess: What Cushing's syndrome can teach us? Biochem Pharmacol 2024; 223:116137. [PMID: 38494065 DOI: 10.1016/j.bcp.2024.116137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Endogenous Cushing's syndrome (CS) is a rare condition due to prolonged exposure to elevated circulating cortisol levels that features its typical phenotype characterised by moon face, proximal myopathy, easy bruising, hirsutism in females and a centripetal distribution of body fat. Given the direct and indirect effects of hypercortisolism, CS is a severe disease burdened by increased cardio-metabolic morbidity and mortality in which visceral adiposity plays a leading role. Although not commonly found in clinical setting, endogenous CS is definitely underestimated leading to delayed diagnosis with consequent increased rate of complications and reduced likelihood of their reversal after disease control. Most of all, CS is a unique model for systemic impairment induced by exogenous glucocorticoid therapy that is commonly prescribed for a number of chronic conditions in a relevant proportion of the worldwide population. In this review we aim to summarise on one side, the mechanisms behind visceral adiposity and lipid metabolism impairment in CS during active disease and after remission and on the other explore the potential role of cortisol in promoting adipose tissue accumulation.
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Affiliation(s)
- Alessandro Bavaresco
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Pierluigi Mazzeo
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Martina Lazzara
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Mattia Barbot
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy.
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2
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Aedla NR, Mahmood T, Ahmed B, Konje JC. Challenges in timing and mode of delivery in morbidly obese women. Best Pract Res Clin Obstet Gynaecol 2024; 92:102425. [PMID: 38150814 DOI: 10.1016/j.bpobgyn.2023.102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
Globally obesity is increasing especially in the reproductive age group. Pregnant women with obesity have higher complication and intervention rates. They are also at increased risk of stillbirth and intrapartum complications. Although organisations like NICE, RCOG, ACOG and WHO have published guidelines and recommendations on care of pregnant women with obesity the evidence from which Grade A recommendations can be made on timing and how to deliver is limited. The current advice is therefore to have discussions with the woman on risks to help her make an informed decision about timing, place, and mode of delivery. Obesity is an independent risk factor for pregnancy complications including diabetes, hypertension and macrosomia. In those with these complications, the timing of delivery is often influenced by the severity of the complication. As an independent factor, population based observational studies in obese women have shown an increase in the risk of stillbirth. This risk increases linearly with weight from overweight through to class II obesity, but then rises sharply in those with class III obesity by at least 10-fold beyond 42 weeks when compared to normal weight women. This risk of stillbirth is notably higher in obese women from 34 weeks onwards compared to normal weight women. One modifiable risk factor for stillbirth as shown from various cohorts of pregnant women is prolonged pregnancy. Research has linked obesity to prolonged pregnancy. Although the exact mechanism is yet unknown some have linked this to maternal dysregulation of the hypothalamic pituitary adrenal axis leading to hormonal imbalance delaying parturition. For these women the two dilemmas are when and how best to deliver. In this review, we examine the evidence and make recommendations on the timing and mode of delivery in women with obesity. For class I obese women there are no differences in outcome with regards to timing and mode of delivery when compared to lean weight women. However, for class II and III obesity, planned induction or caesarean sections may be associated with a lower perinatal morbidity and mortality although this may be associated with an increased in maternal morbidity especially in class III obesity. Studies have shown that delivery by 39 weeks is associated with lower perinatal mortality compared to delivering after in these women. On balance the evidence would favour planned delivery (induction or caesarean section) before 40 weeks of gestation. In the morbidly obese, apart from the standard lower transverse skin incision for CS, there is evidence that a supraumbilical transverse incision may reduce morbidity but is less cosmetic. Irrespective of the option adopted, it is important to discuss the pros and cons of each.
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Affiliation(s)
- Nivedita R Aedla
- Simpsons Centre for Reproductive Medicine Royal Infirmary of Edinburgh, Edinburgh, UK.
| | | | - Badreldeen Ahmed
- Fetal Maternal Centre, Doha, Qatar; Weill Cornell Medicine Qatar. Qatar; University of Qatar, Qatar
| | - Justin C Konje
- Fetal Maternal Centre, Doha, Qatar; Weill Cornell Medicine Qatar. Qatar; Department of Health Sciences, University of Leicester, UK; University of Ho, Ghana
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Janssen JAMJL. New Insights into the Role of Insulin and Hypothalamic-Pituitary-Adrenal (HPA) Axis in the Metabolic Syndrome. Int J Mol Sci 2022; 23:ijms23158178. [PMID: 35897752 PMCID: PMC9331414 DOI: 10.3390/ijms23158178] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Recent data suggests that (pre)diabetes onset is preceded by a period of hyperinsulinemia. Consumption of the "modern" Western diet, over-nutrition, genetic background, decreased hepatic insulin clearance, and fetal/metabolic programming may increase insulin secretion, thereby causing chronic hyperinsulinemia. Hyperinsulinemia is an important etiological factor in the development of metabolic syndrome, type 2 diabetes, cardiovascular disease, polycystic ovarian syndrome, and Alzheimer's disease. Recent data suggests that the onset of prediabetes and diabetes are preceded by a variable period of hyperinsulinemia. Emerging data suggest that chromic hyperinsulinemia is also a driving force for increased activation of the hypothalamic-adrenal-pituitary (HPA) axis in subjects with the metabolic syndrome, leading to a state of "functional hypercortisolism". This "functional hypercortisolism" by antagonizing insulin actions may prevent hypoglycemia. It also disturbs energy balance by shifting energy fluxes away from muscles toward abdominal fat stores. Synergistic effects of hyperinsulinemia and "functional hypercortisolism" promote abdominal visceral obesity and insulin resistance which are core pathophysiological components of the metabolic syndrome. It is hypothesized that hyperinsulinemia-induced increased activation of the HPA axis plays an important etiological role in the development of the metabolic syndrome and its consequences. Numerous studies have demonstrated reversibility of hyperinsulinemia with lifestyle, surgical, and pharmaceutical-based therapies. Longitudinal studies should be performed to investigate whether strategies that reduce hyperinsulinemia at an early stage are successfully in preventing increased activation of the HPA axis and the metabolic syndrome.
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Affiliation(s)
- Joseph A M J L Janssen
- Department of Internal Medicine, Erasmus Medical Center, Room Rg527, 3015 GD Rotterdam, The Netherlands
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de Souza CF, Stopa LRS, Martins AB, Wunderlich ALM, Lopes GM, Zaia DAM, Zaia CTBV, de Andrade FG, Leite CM, Uchoa ET. Lactation overnutrition-induced obesity impairs effects of exogenous corticosterone on energy homeostasis and hypothalamic-pituitary-adrenal axis in male rats. Life Sci 2022; 304:120721. [PMID: 35716735 DOI: 10.1016/j.lfs.2022.120721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
AIMS Litter size reduction on the first days of life results in increased body weight and adiposity, with higher levels of circulating glucocorticoids. Obese rodents are more sensitive to the anabolic effects of glucocorticoids and less responsive to glucocorticoids feedback on hypothalamic-pituitary-adrenal (HPA) axis. This study aimed to evaluate effects of the treatment with corticosterone on metabolic responses and HPA axis in adult male rats reared in small litters. MAIN METHODS From postnatal day (PND) 60 to 88, adult male rats of normal (NL- 10 pups/dam) and small (SL- 3 pups/dam) litters received oral treatment with Corticosterone (CORT-15 mg/L) in the drinking water or no treatment, composing the four experimental groups (NL-water; NL-CORT; SL-water and SL-CORT), for the evaluation of energy homeostasis and HPA axis. KEY FINDINGS Male rats of SL-water group presented on PND88: glucose intolerance, higher adiposity, plasma triglycerides, free fatty acids, total and low-density lipoprotein (LDL) cholesterol and corticosterone. SL-water animals showed increased mRNA of corticotrophin-releasing hormone (CRH) in the hypothalamic paraventricular nucleus (PVN) and proopiomelanocortin (POMC) in the pituitary, with decreased mRNA expression of PVN mineralocorticoid receptor. NL-CORT animals presented glucose intolerance, increased body weight, food intake, total and LDL cholesterol. Glucocorticoid treatment reduced corticosterone levels and adrenal cortex thickness in NL group, associated with increased mRNA of PVN CRH and pituitary POMC, without effects on SL animals. SIGNIFICANCE Lactation overnutrition promotes hyperreactivity of HPA axis and reduces the responsiveness to glucocorticoids effects on energy balance and negative feedback of HPA axis in adult male rats.
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Affiliation(s)
- Camila F de Souza
- Multicenter Postgraduate Program in Physiological Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Larissa Rugila S Stopa
- Postgraduate Program in Physiological Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Andressa B Martins
- Multicenter Postgraduate Program in Physiological Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Ana Luiza M Wunderlich
- Postgraduate Program in Physiological Sciences, State University of Londrina, Londrina, PR, Brazil
| | | | - Dimas A M Zaia
- Department of Chemistry, State University of Londrina, Londrina, PR, Brazil
| | - Cassia Thaïs B V Zaia
- Department of Physiological Sciences, State University of Londrina, Londrina, PR, Brazil
| | | | | | - Ernane Torres Uchoa
- Department of Physiological Sciences, State University of Londrina, Londrina, PR, Brazil.
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Kluwe B, Zhao S, Kline D, Ortiz R, Brock G, Echouffo-Tcheugui JB, Sims M, Kalyani RR, Golden SH, Joseph JJ. Adiposity Measures and Morning Serum Cortisol in African Americans: Jackson Heart Study. Obesity (Silver Spring) 2021; 29:418-427. [PMID: 33491313 PMCID: PMC9017492 DOI: 10.1002/oby.23056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/28/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Altered hormonal regulation, including cortisol, is a proposed mechanism linking adiposity to obesity-related disorders. We examined the association of anthropometric, adipokine, and body fat distribution measures of adiposity with morning serum cortisol in an African American (AA) cohort. METHODS We investigated the cross-sectional associations of adiposity measures (BMI, waist circumference, leptin, adiponectin, leptin:adiponectin ratio, subcutaneous and visceral adipose tissue) and liver attenuation with cortisol in the Jackson Heart Study. Linear regression models were used to analyze the association between exposures and cortisol. Models were adjusted for multiple covariates. RESULTS Among 4,211 participants, a 1-SD higher BMI and waist circumference were associated with a 3.92% and 3.05% lower cortisol, respectively. A 1-SD higher leptin and leptin:adiponectin ratio were associated with a 6.48% and 4.97% lower morning serum cortisol, respectively. A 1-SD higher subcutaneous adipose tissue was associated with a 4.97% lower cortisol (all P < 0.001). There were no associations of liver attenuation or visceral adipose tissue with cortisol. CONCLUSIONS Several measures of adiposity are associated with lower morning serum cortisol among AAs, with leptin having the greatest magnitude. Future studies examining the role of morning serum cortisol in the pathway from adiposity to cardiometabolic disease in AAs are warranted.
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Affiliation(s)
- Bjorn Kluwe
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - David Kline
- Department of Biomedical Informatics and Center for Biostatistics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Robin Ortiz
- Department of Internal Medicine and Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, University of Mississippi, Jackson, Mississippi, USA
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes and Metabolism, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes and Metabolism, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua J. Joseph
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Hristov I, Mocanu V, Zugun-Eloae F, Labusca L, Cretu-Silivestru I, Oboroceanu T, Tiron C, Tiron A, Burlacu A, Pinzariu AC, Armasu I, Neagoe RM, Covic A, Scripcariu V, Timofte DV. Association of intracellular lipid accumulation in subcutaneous adipocyte precursors and plasma adipokines in bariatric surgery candidates. Lipids Health Dis 2019; 18:141. [PMID: 31189474 PMCID: PMC6563373 DOI: 10.1186/s12944-019-1081-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The adipocyte expansion is a critical process with implications in the pathogenesis of obesity associated metabolic syndrome. Impaired adipogenesis leads to dysfunctional, hypertrophic adipocytes, local inflammation and peripheric insulin resistance. METHODS We assessed the relationship between the adipogenic differentiation capacity of the subcutaneous adipose derived stem cells (ASCs), evaluated by total lipid accumulation, and the metabolic and hormonal profile in a group of obese female patients proposed for bariatric surgery (N = 20) versus normal weight female controls (N = 7). RESULTS The lipid accumulation (measured as optical density at 492 nm) of ASCs during their differentiation to adipocytes was significantly lower in ASCs isolated from obese patients as compared to ASCs isolated from normal weight patients (0.49 ± 0.1 vs. 0.71 ± 0.1, p < 0.001). Significant negative correlations between lipid accumulation in adipogenic differentiated ASCs and plasma concentrations of triglycerides (p < 0.01), insulin (p < 0.001), HOMA-IR (p < 0.01), adiponectin (p < 0.05) and leptin/adiponectin ratio (p < 0.05) were found in obese group. CONCLUSIONS In severely obese female patients, the abnormal adipogenesis is related to insulin resistance and leptin/adiponectin ratio. The abnormal lipid accumulation in the mature adipocyte derived from obese ASCs could possible predict the further development of type 2 diabetes mellitus in severely obese patients and influence the selection of patients for bariatric surgery.
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Affiliation(s)
- Ioana Hristov
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
| | - Veronica Mocanu
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania.
| | - Florin Zugun-Eloae
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
- TRANSCEND Research Center, Regional Institute of Oncology, Iasi, Romania
| | - Luminita Labusca
- Stem Cell Laboratory, National Institute of Research and Development for Technical Physics (NIRDTP), Iasi, Romania
| | - Iustina Cretu-Silivestru
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
| | - Teodor Oboroceanu
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
| | - Crina Tiron
- TRANSCEND Research Center, Regional Institute of Oncology, Iasi, Romania
| | - Adrian Tiron
- TRANSCEND Research Center, Regional Institute of Oncology, Iasi, Romania
| | - Alexandrina Burlacu
- "Nicolae Simionescu" Institute of Cellular Biology and Pathology of the Romanian Academy, Bucharest, Romania
| | - Alin Constantin Pinzariu
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
| | - Ioana Armasu
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
| | - Radu Mircea Neagoe
- University of Medicine, Pharmacy, Sciences and Technology, Tg Mures, Romania
| | - Adrian Covic
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
- Academy of Medical Sciences, Bucharest, Romania
| | - Viorel Scripcariu
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
| | - Daniel Vasile Timofte
- "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115, Iasi, Romania
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Petrosus E, Silva EB, Lay D, Eicher SD. Effects of orally administered cortisol and norepinephrine on weanling piglet gut microbial populations and Salmonella passage. J Anim Sci 2018; 96:4543-4551. [PMID: 30060210 PMCID: PMC6373921 DOI: 10.1093/jas/sky312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/27/2018] [Indexed: 12/22/2022] Open
Abstract
Stress and anxiety have been associated with changes in the microbiota of the gut and ultimately diminished resistance to pathogens. The objective of this study was to observe intestinal microbiota and susceptibility to Salmonella associated with stress hormones, cortisol (CORT), and norepinephrine (NE), in piglets. At weaning, 90 piglets (15 for a Salmonella challenge) were trained to take the carrier (apple juice) orally. At 2 wk after weaning, pens of piglets were assigned randomly to 1 of 3 treatments: control (CNT), NE, or CORT. Blood samples were collected prior to treatment, then piglets were dosed orally with treatments twice on day 0; at 0800 and 1600 h. Control piglets were administered 6.1 mL of the carrier only, NE pigs were administered 40 mg/mL of NE-bitartrate salt dissolved in the carrier, and CORT pigs were administered 12 mg/mL of hydrocortisone acetate dissolved in the carrier. Jugular blood samples were collected prior to necropsies (n = 5/treatment) at 0800 and 1600 h on day 1, and at 0800 h on days 2, 7, and 14 after treatments were started. A subset of pigs were subjected to a 24-h Salmonella challenge. Jejunal and ileal tissues and jejunal, ileal, cecal, and rectal contents were collected and colonies were counted. Microbial data and blood samples were analyzed using mixed models with fixed effects of treatment and day. Cortisol-treated piglets exhibited a spike in plasma CORT concentrations at 0800 h day 1 (P = 0.001) accompanied by greater concentrations of cecal Escherichia coli (P < 0.05) and a shift in intestinal environment to favor coliforms on day 2 (P < 0.05). Salmonella concentrations from rectal contents tended (P = 0.07) to be suppressed by CORT. Lactic acid-producing bacteria rectal concentrations were greater (P = 0.03) in CORT pigs on 0800 h on day 1 then NE pigs and tended to be greater than CNT (P = 0.09) and were greater on day 14 for both CNT (P = 0.003) and NE (P = 0.02). Norepinephrine spiked in NE piglets at 0800 h on day 1 (P = 0.001), 1600 h day 1 (P = 0.004), through day 2 (P = 0.04). Intestinal environment of NE pigs shifted to favor ileal anaerobes (P ≤ 0.05) and facultative anaerobes (E. coli; P = 0.01) compared to CNT. However, Salmonella concentrations in rectal contents were suppressed by NE compared to CNT (P = 0.05). Oral administration of NE and CORT had the desired effect of increasing concentrations of stress hormones and resulted in microbiome shifts throughout the intestines.
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Affiliation(s)
- Elizabeth Petrosus
- Department of Animal Science, Purdue University, West Lafayette, Indiana
| | - Ediane B Silva
- Livestock Behavior Research Unit, Agricultural Research Services, United States Department of Agriculture, West Lafayette, Indiana
| | - Don Lay
- Livestock Behavior Research Unit, Agricultural Research Services, United States Department of Agriculture, West Lafayette, Indiana
| | - Susan D Eicher
- Livestock Behavior Research Unit, Agricultural Research Services, United States Department of Agriculture, West Lafayette, Indiana
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Walker CK, VandeVoort CA, Li CS, Chaffin CL, Capitanio JP. Adiposity and weight gain during pregnancy associate independently with behavior of infant rhesus monkeys (Macaca mulatta). Dev Psychobiol 2018; 60:629-638. [PMID: 29900528 DOI: 10.1002/dev.21744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/17/2018] [Accepted: 03/12/2018] [Indexed: 12/27/2022]
Abstract
Growing evidence identifies maternal adiposity as a potentially modifiable risk factor for adverse neurodevelopment. This retrospective cohort analysis examined whether maternal prepregnancy adiposity and gestational weight gain were associated with behavioral outcomes in 173 rhesus macaque infants at the California National Primate Research Center. Dams conceived indoors, had uncomplicated pregnancies, delivered vaginally, and reared infants indoors. Infants underwent standardized biobehavioral analysis at 90-120 days of age from 3/2001-5/2015. Offspring of mothers with greater baseline adiposity or gestational weight gain exhibited a pattern of poor adaptability characterized by greater emotionality as the assessments proceeded, blunted affective response to a human intruder challenge, and reduced interest in novel stimuli which is associated with poorer social functioning later in life. They also had lower cortisol levels following dexamethasone suppression, perhaps a response to cortisol excess during gestation. These results amplify growing public health concerns implicating maternal adiposity in impaired fetal neurobehavioral programming.
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Affiliation(s)
- Cheryl K Walker
- Department of Obstetrics and Gynecology, School of Medicine, University of California, Davis, California.,Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, California.,California National Primate Research Center, University of California, Davis, California
| | - Catherine A VandeVoort
- Department of Obstetrics and Gynecology, School of Medicine, University of California, Davis, California.,California National Primate Research Center, University of California, Davis, California
| | - Chin-Shang Li
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California
| | - Charles L Chaffin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland
| | - John P Capitanio
- California National Primate Research Center, University of California, Davis, California.,Department of Psychology, University of California, Davis, California
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Ueland GÅ, Methlie P, Kellmann R, Bjørgaas M, Åsvold BO, Thorstensen K, Kelp O, Thordarson HB, Mellgren G, Løvås K, Husebye ES. Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test. Eur J Endocrinol 2017; 176:705-713. [PMID: 28298353 DOI: 10.1530/eje-17-0078] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The overnight dexamethasone (DXM) suppression test (DST) has high sensitivity, but moderate specificity, for diagnosing hypercortisolism. We have evaluated if simultaneous measurement of S-DXM may correct for variable DXM bioavailability and increase the diagnostic performance of DST, and if saliva (sa) is a feasible adjunct or alternative to serum. DESIGN AND METHODS Prospective study of DST was carried out in patients with suspected Cushing's syndrome (CS) (n = 49), incidentaloma (n = 152) and healthy controls (n = 101). Cortisol, cortisone and DXM were assayed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS Three hundred and two subjects underwent DST; S-cortisol was ≥50 nmol/L in 83 patients, of whom 11 had CS and 27 had autonomous cortisol secretion. The lower 2.5 percentile of S-DXM in subjects with negative DST (n = 208) was 3.3 nmol/L, which was selected as the DXM cut-off level. Nine patients had the combination of low S-DXM and positive DST. Of these, three had been misdiagnosed as having autonomous cortisol secretion. DST results were highly reproducible and confirmed in a replication cohort (n = 58). Patients with overt CS had significantly elevated post-DST sa-cortisol and sa-cortisone levels compared with controls; 23 of 25 with autonomous cortisol secretion had elevated sa-cortisone and 14 had elevated sa-cortisol. CONCLUSIONS Simultaneous measurement of serum DXM and cortisol reduced false-positive DSTs by 20% and improved the specificity. S-DXM >3.3 nmol/L is sufficient for the suppression of cortisol <50 nmol/L. Measurement of glucocorticoids in saliva is a non-invasive and easy procedure and post-DST sa-cortisone was found particularly useful in the diagnosis of CS.
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Affiliation(s)
- Grethe Å Ueland
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of Medicine
- Department of the Hormone LaboratoryHaukeland University Hospital, Bergen, Norway
| | - Paal Methlie
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of Medicine
| | - Ralf Kellmann
- Department of the Hormone LaboratoryHaukeland University Hospital, Bergen, Norway
| | - Marit Bjørgaas
- Department of EndocrinologySt. Olav's Hospital, Trondheim, Norway
| | - Bjørn O Åsvold
- Department of EndocrinologySt. Olav's Hospital, Trondheim, Norway
- Department of Public Health and General PracticeNorwegian University of Science and Technology, Trondheim, Norway
| | | | - Oskar Kelp
- Department of EndocrinologyAkershus University Hospital, Lørenskog, Norway
| | | | - Gunnar Mellgren
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of the Hormone LaboratoryHaukeland University Hospital, Bergen, Norway
| | - Kristian Løvås
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of Medicine
| | - Eystein S Husebye
- Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
- Department of Medicine
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10
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Joseph JJ, Wang X, Diez Roux AV, Sanchez BN, Seeman TE, Needham BL, Golden SH. Antecedent longitudinal changes in body mass index are associated with diurnal cortisol curve features: The multi-ethnic study of atherosclerosis. Metabolism 2017; 68:95-107. [PMID: 28183457 PMCID: PMC5312946 DOI: 10.1016/j.metabol.2016.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/15/2016] [Accepted: 12/05/2016] [Indexed: 01/05/2023]
Abstract
CONTEXT Prior studies have shown a cross-sectional association between body mass index (BMI) and salivary diurnal cortisol profile features (cortisol features); however, to our knowledge prior population-based studies have not examined the longitudinal association of body-mass index (BMI) with cortisol features. OBJECTIVE To examine the association of (1) prior annual BMI percent change over 7years with cortisol features, (2) baseline cortisol features with subsequent change in BMI over 6years and (3) the association of change in cortisol features with change in BMI over 6years. DESIGN Longitudinal study. SETTING Multi-Ethnic Study of Atherosclerosis (MESA) Stress I & II Studies (2004-2006 & 2010-2012). PARTICIPANTS 1685 ethnically diverse men and women attended either MESA Stress exam (mean age 65±10years at MESA Stress I; mean age 69±9years at MESA Stress II). OUTCOME MEASURES Log-transformed cortisol features including wake-up cortisol, cortisol awakening response, early decline slope (30min to 2h post-awakening), late decline slope (2h post-awakening to bedtime), bedtime, and total area under the curve (AUC) cortisol. RESULTS Over 7years, following multivariable adjustment, (1) a 1% higher prior annual BMI % increase was associated with a 2.9% (95% CI: -5.0%, -0.8%) and 3.0% (95% CI: -4.7%, -1.4%) lower current wake-up and total AUC cortisol, respectively; (2) there was no significant association between baseline cortisol features and subsequent change in BMI and (3) among participants with BMI≥30kg/m2, flattening of the late decline slope was associated with increases in BMI (every 1-unit increase late decline slope were associated with a 12.9% increase (95%CI: -1%, 26.8%) in BMI, respectively). CONCLUSIONS We found a significant association between prior annual BMI % change and cortisol features, but no significant association between baseline cortisol features and subsequent change in BMI. In participants with obesity increases in BMI were associated with less pronounced declined. Collectively, our results suggest that greater adiposity may lead to a blunted diurnal cortisol profile.
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Affiliation(s)
- Joshua J Joseph
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
| | - Xu Wang
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Ana V Diez Roux
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Brisa N Sanchez
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Teresa E Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Belinda L Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Sherita Hill Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States
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11
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Bernhardt D, Müller HP, Ludolph AC, Dupuis L, Kassubek J. Body fat distribution in Parkinson's disease: An MRI-based body fat quantification study. Parkinsonism Relat Disord 2016; 33:84-89. [DOI: 10.1016/j.parkreldis.2016.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/22/2016] [Accepted: 09/15/2016] [Indexed: 01/26/2023]
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12
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Maripuu M, Wikgren M, Karling P, Adolfsson R, Norrback KF. Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders. J Affect Disord 2016; 204:187-96. [PMID: 27367307 DOI: 10.1016/j.jad.2016.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/08/2016] [Accepted: 06/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the main causes of excess deaths in affective disorders. Affective disorders are associated with increased frequencies of CVD risk-factors such as obesity, dyslipidemia, and metabolic syndrome. Stress-induced chronic cortisol excess has been suggested to promote obesity and metabolic syndrome. Chronic stress with frequent or persisting hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity may, over time, lead to a state of low HPA-axis activity, also denoted hypocortisolism. A low-dose weight-adjusted dexamethasone-suppression-test (DST) is considered to be a sensitive measure of hypocortisolism. METHODS 245 patients with recurrent depression or bipolar disorder and 258 controls participated in a low-dose DST and were also examined with regard to metabolic status. RESULTS Patients with hypocortisolism (low post-DST cortisol) compared with patients without hypocortisolism (normal or high post-DST cortisol) exhibited increased odds ratios (OR) for obesity (OR=4.0), overweight (OR=4.0), large waist (OR=2.7), high LDL (OR=4.2), low HDL (OR=2.4), high LDL/HDL ratio (OR=3.3), high TC/HDL ratio (OR=3.4) and metabolic syndrome (OR=2.0). A similar pattern but less pronounced was also found in the control sample. LIMITATIONS The cross sectional study design and absence of analyses addressing lifestyle factors. CONCLUSIONS Our findings suggest that a substantial portion of the metabolic disorders and cardiovascular risk factors seen in recurrent affective disorders are found among individuals exhibiting hypocortisolism. This might indicate that long-term stress is a central contributor to metabolic abnormalities and CVD mortality in recurrent affective disorders.
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Affiliation(s)
- Martin Maripuu
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
| | - Mikael Wikgren
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rolf Adolfsson
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Karl-Fredrik Norrback
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Harrell CS, Gillespie CF, Neigh GN. Energetic stress: The reciprocal relationship between energy availability and the stress response. Physiol Behav 2016; 166:43-55. [PMID: 26454211 PMCID: PMC4826641 DOI: 10.1016/j.physbeh.2015.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/17/2015] [Accepted: 10/06/2015] [Indexed: 12/14/2022]
Abstract
The worldwide epidemic of metabolic syndromes and the recognized burden of mental health disorders have driven increased research into the relationship between the two. A maladaptive stress response is implicated in both mental health disorders and metabolic disorders, implicating the hypothalamic-pituitary-adrenal (HPA) axis as a key mediator of this relationship. This review explores how an altered energetic state, such as hyper- or hypoglycemia, as may be manifested in obesity or diabetes, affects the stress response and the HPA axis in particular. We propose that changes in energetic state or energetic demands can result in "energetic stress" that can, if prolonged, lead to a dysfunctional stress response. In this review, we summarize the role of the hypothalamus in modulating energy homeostasis and then briefly discuss the relationship between metabolism and stress-induced activation of the HPA axis. Next, we examine seven mechanisms whereby energetic stress interacts with neuroendocrine stress response systems, including by glucocorticoid signaling both within and beyond the HPA axis; by nutrient-induced changes in glucocorticoid signaling; by impacting the sympathetic nervous system; through changes in other neuroendocrine factors; by inducing inflammatory changes; and by altering the gut-brain axis. Recognizing these effects of energetic stress can drive novel therapies and prevention strategies for mental health disorders, including dietary intervention, probiotics, and even fecal transplant.
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Affiliation(s)
- C S Harrell
- Department of Physiology, Emory University, Atlanta, GA 30322, USA
| | - C F Gillespie
- Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA 30322, USA
| | - G N Neigh
- Department of Physiology, Emory University, Atlanta, GA 30322, USA;; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA 30322, USA.
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14
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Altered diurnal pattern of steroid hormones in relation to various behaviors, external factors and pathologies: A review. Physiol Behav 2016; 164:68-85. [DOI: 10.1016/j.physbeh.2016.05.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 11/17/2022]
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15
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Chiesa L, Panseri S, Pavlovic R, Cannizzo FT, Biolatti B, Divari S, Villa R, Arioli F. HPLC-ESI-MS/MS assessment of the tetrahydro-metabolites of cortisol and cortisone in bovine urine: promising markers of dexamethasone and prednisolone treatment. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2016; 33:1175-89. [DOI: 10.1080/19440049.2016.1202453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Luca Chiesa
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | - Sara Panseri
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | - Radmila Pavlovic
- Department of Chemistry, Faculty of Medicine, University of Nis, Nis, Serbia
| | | | | | - Sara Divari
- Department of Veterinary Science, University of Turin, Grugliasco, Italy
| | - Roberto Villa
- Department of Health, Animal Science and Food Safety, University of Milan, Milan, Italy
| | - Francesco Arioli
- Department of Health, Animal Science and Food Safety, University of Milan, Milan, Italy
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16
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Noppe G, van den Akker ELT, de Rijke YB, Koper JW, Jaddoe VW, van Rossum EFC. Long-term glucocorticoid concentrations as a risk factor for childhood obesity and adverse body-fat distribution. Int J Obes (Lond) 2016; 40:1503-1509. [PMID: 27339603 DOI: 10.1038/ijo.2016.113] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/30/2016] [Accepted: 06/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Childhood obesity is an important risk factor for premature development of the metabolic syndrome (MetS) at adulthood. There is need for understanding of the mechanisms underlying the MetS and obesity. Patients with Cushing's disease suffer from similar metabolic complications, leading to the hypothesis that inter-individual cortisol variation may contribute to the onset of obesity. In addition, glucocorticoid receptor (GR)-gene polymorphisms resulting in differential glucocorticoid (GC) sensitivity, have been associated with an adverse metabolic profile. AIM To study associations of GC levels in scalp hair, as a marker of long-term systemic GC concentrations, and genetically determined GC sensitivity with obesity and body-fat distribution in children. METHODS We performed a cross-sectional study of cortisol and cortisone concentrations over a 3-month period, measured by LC-MS/MS (Liquid Chromatography Tandem Mass Spectrometry) in hair of 3019 6-year-old children participating in the Generation R study. Genotyping of GR-gene polymorphisms was performed. RESULTS Of all children, 4.3% was obese and 13.4% overweight. Cortisol was significantly associated with risk of obesity (odd ratio (OR): 9.4 (3.3-26.9)) and overweight (OR: 1.4 (1.0-2.0)). Cortisone was associated with risk of obesity (OR: 1.9 (1.0-3.5)). Cortisol and cortisone were significantly positively associated with body mass index, fat mass (FM) index and android/gynecoid FM ratio. GR polymorphisms were not associated with adiposity parameters. CONCLUSION Long-term cortisol concentrations are strongly associated with an increased risk of childhood obesity and adverse body-fat distribution. Future research may reveal whether these are causal relations and may be a target for therapy.
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Affiliation(s)
- G Noppe
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E L T van den Akker
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Y B de Rijke
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J W Koper
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V W Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Pecori Giraldi F, Ambrogio AG. Variability in laboratory parameters used for management of Cushing's syndrome. Endocrine 2015; 50:580-9. [PMID: 26160393 PMCID: PMC4662716 DOI: 10.1007/s12020-015-0676-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022]
Abstract
The progress in assay methodology, from the use of radioactive tracers to chemiluminescent signals, from competitive to chromatographic techniques and from serum or urine to saliva has considerably impacted on hormonal measurements. The clinician now may choose among multiple tests but the inherent variability in cortisol and ACTH secretion, coupled to lack of harmonization among assay procedures and normal ranges mandates careful interpretation of any result. The present review will examine factors which affect interpretation of cortisol and ACTH measurements and their impact on tests used for management of Cushing's syndrome.
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Affiliation(s)
- Francesca Pecori Giraldi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano, Via Zucchi 18, 20095, Milan, MI, Italy.
| | - Alberto G Ambrogio
- Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano, Via Zucchi 18, 20095, Milan, MI, Italy
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18
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Incollingo Rodriguez AC, Epel ES, White ML, Standen EC, Seckl JR, Tomiyama AJ. Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity: A systematic review. Psychoneuroendocrinology 2015; 62:301-18. [PMID: 26356039 DOI: 10.1016/j.psyneuen.2015.08.014] [Citation(s) in RCA: 250] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although there is substantial evidence of differential hypothalamic-pituitary-adrenal (HPA) axis activity in both generalized and abdominal obesity, consistent trends in obesity-related HPA axis perturbations have yet to be identified. OBJECTIVES To systematically review the existing literature on HPA activity in obesity, identify possible explanations for inconsistencies in the literature, and suggest methodological improvements for future study. DATA SOURCES Included papers used Pubmed, Google Scholar, and the University of California Library search engines with search terms body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, sagittal diameter, abdominal versus peripheral body fat distribution, body fat percentage, DEXA, abdominal obesity, and cortisol with terms awakening response, slope, total daily output, reactivity, feedback sensitivity, long-term output, and 11β-HSD expression. STUDY ELIGIBILITY CRITERIA Empirical research papers were eligible provided that they included at least one type of obesity (general or abdominal), measured at least one relevant cortisol parameter, and a priori tested for a relationship between obesity and cortisol. RESULTS A general pattern of findings emerged where greater abdominal fat is associated with greater responsivity of the HPA axis, reflected in morning awakening and acute stress reactivity, but some studies did show underresponsiveness. When examined in adipocytes, there is a clear upregulation of cortisol output (due to greater expression of 11β-HSD1), but in hepatic tissue this cortisol is downregulated. Overall obesity (BMI) appears to also be related to a hyperresponsive HPA axis in many but not all studies, such as when acute reactivity is examined. LIMITATIONS The reviewed literature contains numerous inconsistencies and contradictions in research methodologies, sample characteristics, and results, which partially precluded the development of clear and reliable patterns of dysregulation in each investigated cortisol parameter. CONCLUSIONS AND IMPLICATIONS The literature to date is inconclusive, which may well arise from differential effects of generalized obesity vs. abdominal obesity or from modulators such as sex, sex hormones, and chronic stress. While the relationship between obesity and adipocyte cortisol seems to be clear, further research is warranted to understand how adipocyte cortisol metabolism influences circulating cortisol levels and to establish consistent patterns of perturbations in adrenal cortisol activity in both generalized and abdominal obesity.
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Affiliation(s)
| | - Elissa S Epel
- University of California, San Francisco, CA 94118, USA
| | - Megan L White
- University of California, Los Angeles, CA 90095, USA
| | | | - Jonathan R Seckl
- University of Edinburgh, Edinburgh EH1 1HT, Scotland, United Kingdom
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19
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Casulari LA, Dondi D, Celotti F, da Silva FVP, Reis CEG, da Costa THM. Effects of caloric restriction and low glycemic index diets associated with metformin on glucose metabolism and cortisol response in overweight/obese subjects: a case series study. Diabetol Metab Syndr 2015; 7:65. [PMID: 26269722 PMCID: PMC4533768 DOI: 10.1186/s13098-015-0057-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/23/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To determine whether cortisol secretion and glucocorticoid receptors in lymphocytes and monocytes are altered in patients with impaired glucose tolerance, and whether treatment with a hypocaloric diet and metformin could interfere with these aspects. METHODS This is an analytical, interventional, case series study. Patients with impaired glucose tolerance were included. They received 500 mg of metformin twice daily and followed a low glycemic index diet for 16 weeks. Cortisol levels were assessed at 8:00 A.M. before and after use of 0.25 mg of dexamethasone at 11:00 P.M. the day before. RESULTS Sixteen subjects (9 men) were included. Normal basal levels of cortisol and adequate responses to the low dose of dexamethasone were observed before and after treatment. There was no significant correlation between the parameters evaluated and cortisol levels. Nevertheless, there was a strong correlation between the number of glucocorticoid receptors, BMI (r = 0.88; p = 0.02), and insulin AUC (r = 0.94; p = 0.005) before treatment; after treatment, all these associations ceased to exist. CONCLUSION The cortisol secretion remained normal in the group of patients with impaired glucose tolerance. Treatment with metformin and diet did not change this condition. However, glucocorticoid receptor number had a strong correlation with insulin, due to insulin resistance, but this characteristic was lost after treatment.
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Affiliation(s)
- Luiz Augusto Casulari
- />Unit of Endocrinology, University Hospital Brasilia, University of Brasilia, Brasilia, Brazil
- />CLINEN – Clínica de Neurologia e Endocrinologia. SCN quadra 1, bloco F, Ed. America Office Tower, sala 1111, Brasília, DF 70711-905 Brazil
| | - Donatella Dondi
- />Dipartimento di Scienze Farmacologiche e Biomolecolari, Sezione di Biomedicina ed Endocrinologia, Università di Milano, Milan, Italy
| | - Fabio Celotti
- />Dipartimento di Scienze Farmacologiche e Biomolecolari, Sezione di Biomedicina ed Endocrinologia, Università di Milano, Milan, Italy
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20
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Embi AA, Scherlag BJ. An endocrine hypothesis for the genesis of atrial fibrillation: the hypothalamic-pituitary-adrenal axis response to stress and glycogen accumulation in atrial tissues. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:586-90. [PMID: 25535608 PMCID: PMC4264295 DOI: 10.4103/1947-2714.145478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The underlying role of intracellular glycogen in atrial fibrillation is unknown. Experimental models developed in the goat have shown an increase of intracellular glycogen concentration in atrial myocytes resulting from prolonged pacing induced atrial fibrillation (AF). These observed glycogen molecules are as a result of structural remodeling and are known to replace the intracellular myofibrils causing myolysis in studies done in different animal models. The accumulation of glycogen is progressively and directly related to the duration of pacing-induced AF. Similar responses have been seen in clinically derived atrial tissues. Aims: We intend to present an endocrine hypothesis supported by published evidence that stress acting through the hypothalamic-pituitary-adrenal axis (HPA) is a contributing metabolic factor responsible for the increase of glucose levels via the hormone cortisol. This excess glucose is then metabolized by the myocytes during each heart beat and stored as glycogen. A literature search was done, and published evidence supporting stress was shown to be the main factor for the formation of glucose leading to glycogen deposition to in the cardiac myocytes. Results: Stress on the HPA axis stimulates the adrenal glands to release the hormone cortisol in the blood stream; this in turn increases the cardiac tissue glycogen concentration. It is also known that during each beat, excess glucose is removed by the myocytes and stored as glycogen. As aforementioned, in the cardiac myocytes, dense glycogen content with/without loss of myofibrils has been detected in both human and animal models of AF. Conclusions: We hypothesize that the increase of the intrinsic glycogen concentration and distribution is a result of a metabolic disruption caused by stress through the HPA Axis. For example, in atrial myocytes, the glycogen molecules impede the normal intercellular communications leading to areas of slow conduction favoring reentrant-based AF.
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Affiliation(s)
| | - Benjamin J Scherlag
- Professor of Medicine, University of Oklahoma Health Science Center, Oklahoma, USA
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21
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Roelfsema F, Pereira AM, Veldhuis JD. Impact of Adiposity and Fat Distribution on the Dynamics of Adrenocorticotropin and Cortisol Rhythms. Curr Obes Rep 2014; 3:387-95. [PMID: 26626915 DOI: 10.1007/s13679-014-0118-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Obesity impacts many hormonal systems, including pituitary hormones, as well as insulin and leptin. In this review we discuss articles which investigate the influence of obesity on the hypothalamic-pituitary-adrenal (HPA) axis. Different techniques have been used to assess the function of the HPA-axis in obesity, including measuring fasting and/or late evening levels of adrenocorticotropic hormone (ACTH) and (free) cortisol in plasma and saliva, studying feedback with dexamethasone or cortisol, and evaluating responsiveness of the system to corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) or ACTH 1-29. In addition, more elaborate studies investigated 24-h secretion patterns, analyzed with deconvolution techniques to quantitate pulsatile secretion rates of cortisol and less often ACTH. Other investigators used timed infusions of labeled cortisol for the estimation of the 24-h secretion rate, clearance rate and distribution volume. Many studies relied on the 24-h urinary excretion of free cortisol, but for quantitation of the 24-h secretion, measurement of all cortisol-derived metabolites is required. Several studies have applied modern liquid chromatography-tandem-mass spectrometry techniques to measure these metabolites. The picture emerging from all these studies is that, first, ACTH secretion is amplified, likely via enhanced forward drive; and, second, serum cortisol levels are normal or even low, associated with a normal 24-h cortisol secretion per liter distribution volume determined by deconvolution, but enhanced when based on the increased total distribution volume associated with obesity. Increased cortisol secretion was also established by isotope dilution studies and reports based on the measurement of all urinary cortisol metabolites. The responsiveness of the adrenal gland to ACTH is diminished. The studies do not address quantitative aspects of cortisol-cortisone metabolism on individual organs, including liver, central and peripheral fat, intestine, skin, and muscle.
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Affiliation(s)
- Ferdinand Roelfsema
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
| | - Alberto M Pereira
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Johannes D Veldhuis
- Endocrine Research Unit, Mayo Medical and Graduate Schools, Clinical Translational Research Center, Mayo Clinic, Rochester, MN, 55901, USA
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22
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DiSilvestro D, Petrosino J, Aldoori A, Melgar-Bermudez E, Wells A, Ziouzenkova O. Enzymatic intracrine regulation of white adipose tissue. Horm Mol Biol Clin Investig 2014; 19:39-55. [PMID: 25390015 DOI: 10.1515/hmbci-2014-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/28/2014] [Indexed: 11/15/2022]
Abstract
Abdominal fat formation has become a permanent risk factor for metabolic syndrome and various cancers in one-third of the world's population of obese and even lean patients. Formation of abdominal fat involves additional mechanisms beyond an imbalance in energy intake and expenditure, which explains systemic obesity. In this review, we briefly summarized autonomous regulatory circuits that locally produce hormones from inactive precursors or nutrients for intra-/auto-/paracrine signaling in white adipose depots. Enzymatic pathways activating steroid and thyroid hormones in adipose depots were compared with enzymatic production of retinoic acid from vitamin A. We discussed the role of intracrine circuits in fat-depot functions and strategies to reduce abdominal adiposity through thermogenic adipocytes with interrupted generation of retinoic acid.
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23
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Leliavski A, Dumbell R, Ott V, Oster H. Adrenal Clocks and the Role of Adrenal Hormones in the Regulation of Circadian Physiology. J Biol Rhythms 2014; 30:20-34. [DOI: 10.1177/0748730414553971] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The mammalian circadian timing system consists of a master pacemaker in the suprachiasmatic nucleus (SCN) and subordinate clocks that disseminate time information to various central and peripheral tissues. While the function of the SCN in circadian rhythm regulation has been extensively studied, we still have limited understanding of how peripheral tissue clock function contributes to the regulation of physiological processes. The adrenal gland plays a special role in this context as adrenal hormones show strong circadian secretion rhythms affecting downstream physiological processes. At the same time, they have been shown to affect clock gene expression in various other tissues, thus mediating systemic entrainment to external zeitgebers and promoting internal circadian alignment. In this review, we discuss the function of circadian clocks in the adrenal gland, how they are reset by the SCN and may further relay time-of-day information to other tissues. Focusing on glucocorticoids, we conclude by outlining the impact of adrenal rhythm disruption on neuropsychiatric, metabolic, immune, and malignant disorders.
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Affiliation(s)
- Alexei Leliavski
- Chronophysiology Group, Medical Department, University of Lübeck, Germany
| | - Rebecca Dumbell
- Chronophysiology Group, Medical Department, University of Lübeck, Germany
| | - Volker Ott
- Institute of Neuroendocrinology, University of Lübeck, Germany
| | - Henrik Oster
- Chronophysiology Group, Medical Department, University of Lübeck, Germany
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Corey SM, Epel E, Schembri M, Pawlowsky SB, Cole RJ, Araneta MRG, Barrett-Connor E, Kanaya AM. Effect of restorative yoga vs. stretching on diurnal cortisol dynamics and psychosocial outcomes in individuals with the metabolic syndrome: the PRYSMS randomized controlled trial. Psychoneuroendocrinology 2014; 49:260-71. [PMID: 25127084 PMCID: PMC4174464 DOI: 10.1016/j.psyneuen.2014.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Chronic stimulation and dysregulation of the neuroendocrine system by stress may cause metabolic abnormalities. We estimated how much cortisol and psychosocial outcomes improved with a restorative yoga (relaxation) versus a low impact stretching intervention for individuals with the metabolic syndrome. METHODS We conducted a 1-year multi-center randomized controlled trial (6-month intervention and 6-month maintenance phase) of restorative yoga vs. stretching. Participants completed surveys to assess depression, social support, positive affect, and stress at baseline, 6 months and 12 months. For each assessment, we collected saliva at four points daily for three days and collected response to dexamethasone on the fourth day for analysis of diurnal cortisol dynamics. We analyzed our data using multivariate regression models, controlling for study site, medications (antidepressants, hormone therapy), body mass index, and baseline cortisol values. RESULTS Psychosocial outcome measures were available for 171 study participants at baseline, 140 at 6 months, and 132 at 1 year. Complete cortisol data were available for 136 of 171 study participants (72 in restorative yoga and 64 in stretching) and were only available at baseline and 6 months. At 6 months, the stretching group had decreased cortisol at waking and bedtime compared to the restorative yoga group. The pattern of changes in stress mirrored this improvement, with the stretching group showing reductions in chronic stress severity and perseverative thoughts about their stress. Perceived stress decreased by 1.5 points (-0.4; 3.3, p=0.11) at 6 months, and by 2.0 points (0.1; 3.9, p=0.04) at 1 year in the stretching compared to restorative yoga groups. Post hoc analyses suggest that in the stretching group only, perceived increases in social support (particularly feelings of belonging), but not changes in stress were related to improved cortisol dynamics. CONCLUSIONS We found significant decreases in salivary cortisol, chronic stress severity, and stress perception in the stretching group compared to the restorative yoga group. Group support during the interactive stretch classes may have contributed to these changes.
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Affiliation(s)
- Sarah M Corey
- University of California, San Francisco, CA 94115, USA.
| | - Elissa Epel
- University of California, San Francisco, CA 94115, USA
| | | | | | - Roger J Cole
- Synchrony Applied Health Sciences, Del Mar, CA 92014, USA
| | | | | | - Alka M Kanaya
- University of California, San Francisco, CA 94115, USA
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25
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Aschbacher K, Rodriguez-Fernandez M, van Wietmarschen H, Tomiyama AJ, Jain S, Epel E, Doyle FJ, van der Greef J. The hypothalamic-pituitary-adrenal-leptin axis and metabolic health: a systems approach to resilience, robustness and control. Interface Focus 2014; 4:20140020. [PMID: 25285198 DOI: 10.1098/rsfs.2014.0020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Glucocorticoids contribute to obesity and metabolic syndrome; however, the mechanisms are unclear, and prognostic measures are unavailable. A systems level understanding of the hypothalamic-pituitary-adrenal (HPA)-leptin axis may reveal novel insights. Eighteen obese premenopausal women provided blood samples every 10 min over 24 h, which were assayed for cortisol, adrenocorticotropin releasing hormone (ACTH) and leptin. A published personalized HPA systems model was extended to incorporate leptin, yielding three parameters: (i) cortisol inhibitory feedback signalling, (ii) ACTH-adrenal signalling, and (iii) leptin-cortisol antagonism. We investigated associations between these parameters and metabolic risk profiles: fat and lean body mass (LBM; using dual-energy X-ray absorptiometry), and insulin resistance. Decreased cortisol inhibitory feedback signalling was significantly associated with greater fat (kg; p = 0.01) and insulin resistance (p = 0.03) but not LBM. Leptin significantly antagonized cortisol dynamics in eight women, who exhibited significantly lower 24 h mean leptin levels, LBM and higher ACTH-adrenal signalling nocturnally (all p < 0.05), compared with women without antagonism. Traditional neuroendocrine measures did not predict metabolic health, whereas a dynamic systems approach revealed that lower central inhibitory cortisol feedback signalling was significantly associated with greater metabolic risk. While exploratory, leptin-cortisol antagonism may reflect a 'neuroendocrine starvation' response.
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Affiliation(s)
- Kirstin Aschbacher
- Department of Psychiatry , University of California , San Francisco, CA , USA ; The Institute for Integrative Health , Baltimore, MD , USA
| | | | - Herman van Wietmarschen
- TNO Innovation for Life , Zeist , The Netherlands ; Department of Analytical Biosciences , Leiden University , Leiden , The Netherlands
| | - A Janet Tomiyama
- Department of Psychology , University of California , Los Angeles, CA , USA
| | - Shamini Jain
- Department of Brain, Mind & Healing , Samueli Institute , Alexandria, VA , USA ; Department of Psychiatry , University of California , San Diego, CA , USA
| | - Elissa Epel
- Department of Psychiatry , University of California , San Francisco, CA , USA
| | - Francis J Doyle
- Department of Chemical Engineering , University of California , Santa Barbara, CA , USA
| | - Jan van der Greef
- TNO Innovation for Life , Zeist , The Netherlands ; Department of Analytical Biosciences , Leiden University , Leiden , The Netherlands
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Correia-Branco A, Keating E, Martel F. Maternal undernutrition and fetal developmental programming of obesity: the glucocorticoid connection. Reprod Sci 2014; 22:138-45. [PMID: 25001018 DOI: 10.1177/1933719114542012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
An adequate maternal nutrition during pregnancy is crucial for the health outcome of offspring in adulthood. Maternal undernutrition during critical periods of fetal development can program the fetus for metabolic syndrome (MetS) later in life, especially when postnatally challenged with a hypernutritive diet. Adipogenesis, which begins in utero and accelerates in neonatal life, is a major candidate for developmental programming. During fetal development, the hypothalamic-pituitary-adrenal (HPA) axis is extremely susceptible to programming, and the HPA tone is increased throughout life in undernourished conditions. As a consequence, an alteration in the expression and function of glucocorticoid (GC) receptors and of the major GC regulatory enzymes (11β-hydroxysteroid dehydrogenase 1 and -2) occurs. In this review, we will give insights into the role of maternoplacental adverse interactions under the specific context of maternal undernutrition, for later-in-life MetS development, with a special emphasis on the role of GCs.
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Affiliation(s)
- Ana Correia-Branco
- Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisa Keating
- Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal Center for Biotechnology and Fine Chemistry, School of Biotechnology, Portuguese Catholic University, Porto, Portugal
| | - Fátima Martel
- Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
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Stomby A, Andrew R, Walker BR, Olsson T. Tissue-specific dysregulation of cortisol regeneration by 11βHSD1 in obesity: has it promised too much? Diabetologia 2014; 57:1100-10. [PMID: 24710966 DOI: 10.1007/s00125-014-3228-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/11/2014] [Indexed: 01/24/2023]
Abstract
Cushing's syndrome, caused by increased production of cortisol, leads to metabolic dysfunction including visceral adiposity, hypertension, hyperlipidaemia and type 2 diabetes. The similarities with the metabolic syndrome are striking and major efforts have been made to find obesity-associated changes in the regulation of glucocorticoid action and synthesis, both at a systemic level and tissue level. Obesity is associated with tissue-specific alterations in glucocorticoid metabolism, with increased activity of the glucocorticoid-regenerating enzyme 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) in subcutaneous adipose tissue and decreased conversion of cortisone to cortisol, interpreted as decreased 11βHSD1 activity, in the liver. In addition, genetic manipulation of 11βHSD1 activity in rodents can either induce (by overexpression of Hsd11b1, the gene encoding 11βHSD1) or prevent (by knocking out Hsd11b1) obesity and metabolic dysfunction. Taken together with earlier evidence that non-selective inhibitors of 11βHSD1 enhance insulin sensitivity, these results led to the hypothesis that inhibition of 11βHSD1 might be a promising target for treatment of the metabolic syndrome. Several selective 11βHSD1 inhibitors have now been developed and shown to improve metabolic dysfunction in patients with type 2 diabetes, but the small magnitude of the glucose-lowering effect has precluded their further commercial development.This review focuses on the role of 11βHSD1 as a tissue-specific regulator of cortisol exposure in obesity and type 2 diabetes in humans. We consider the potential of inhibition of 11βHSD1 as a therapeutic strategy that might address multiple complications in patients with type 2 diabetes, and provide our thoughts on future directions in this field.
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Affiliation(s)
- Andreas Stomby
- Department for Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
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Corbalán-Tutau MD, Gómez-Abellán P, Madrid JA, Canteras M, Ordovás JM, Garaulet M. Toward a chronobiological characterization of obesity and metabolic syndrome in clinical practice. Clin Nutr 2014; 34:477-83. [PMID: 24953771 DOI: 10.1016/j.clnu.2014.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/19/2014] [Accepted: 05/14/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND & AIMS To test several circadian rhythm variables in a female population to identify the best tool to assess chronodisruption in obesity and metabolic syndrome (MetS) to define a score to be used for chronodisruption characterization in clinical practice. METHODS Anthropometric measurements and markers of circadian rhythms, such as sleep and feeding diary, Horne-Ostberg questionnaire, melatonin and cortisol measurements, and wrist temperature measurements, were determined. MetS variables were also analyzed. Study was conducted in 70 women. Data were subjected to factor analysis. Receiver operating characteristic curves were used as predictors of chronodisruption risk, and a score was calculated to classify the subjects of risk. RESULTS Factor analysis showed that the first-factor grouped variables were related to the skin temperature measurement. Second factor consisted of variables related to salivary cortisol levels and obesity-related measurements. Third factor included variables related to sleep-wake cycle. Fourth factor referred to peripheral temperature variables and included the classification of subjects according to the Horne-Ostberg questionnaire. To obtain a final punctuation we performed the weighted mean of the first four factors. The final range was from 27 to 57, mean value of 42. Punctuation was defined as the "chronodisruption score." Women displaying higher chronodisruption scores had higher MetS risk. CONCLUSION The study demonstrates that wrist temperature recordings, together with two questions of sleep onset and offset, and one morning salivary cortisol determination could be enough to characterize the chronobiology of obesity and MetS, a new chronodisruption score was developed.
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Affiliation(s)
- M D Corbalán-Tutau
- Department of Physiology, Faculty of Biology, University of Murcia, Murcia, Spain
| | - P Gómez-Abellán
- Department of Physiology, Faculty of Biology, University of Murcia, Murcia, Spain
| | - J A Madrid
- Department of Physiology, Faculty of Biology, University of Murcia, Murcia, Spain
| | - M Canteras
- Department of Biostatistics, University of Murcia, Murcia, Spain
| | - J M Ordovás
- US Department of Agriculture, Human Nutrition Research Center on Aging, Tufts University School of Medicine, Boston, MA, USA; The Department of Epidemiology and Population Genetics, Centro Nacional Investigación Cardiovasculares (CNIC), Madrid, Spain; IMDEA Alimentacion, Madrid, Spain
| | - M Garaulet
- Department of Physiology, Faculty of Biology, University of Murcia, Murcia, Spain.
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Kjölhede EA, Gustafsson PE, Gustafsson PA, Nelson N. Overweight and obese children have lower cortisol levels than normal weight children. Acta Paediatr 2014; 103:295-9. [PMID: 24205857 DOI: 10.1111/apa.12499] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 08/26/2013] [Accepted: 11/04/2013] [Indexed: 11/28/2022]
Abstract
AIM The stress hormone cortisol is vital to survival, and a disturbed circadian rhythm can be deleterious to health. However, little is known about cortisol levels in healthy children. The aim of this study was to examine cortisol levels in relation to body mass index (BMI), age and sex. METHODS Salivary samples were collected in early morning, late morning and evening, on four consecutive days, from 342 children aged 6-12 years using Salivette(®) tubes. Samples were analysed using a commercial enzyme immunoassay (EIA). School nurses measured the children's height and weight, and these measurements were used to calculate their BMI. RESULTS The children displayed a circadian rhythm in cortisol secretion, with morning zeniths and evening nadirs. Average cortisol levels in early morning, late morning and evening were significantly lower in overweight and obese children than in their normal weight counterparts. Cortisol levels did not vary significantly with age or sex. CONCLUSION Our findings may suggest cortisol suppression in overweight and obese children. We found no evidence that sex or age influences cortisol levels. These findings highlight the need for further research on the relationship between stress and obesity in children.
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Affiliation(s)
- E Allansson Kjölhede
- Faculty of Health Sciences; Department of Clinical and Experimental Medicine; Division of Pediatrics; Linköping University; Linköping Sweden
| | - PE Gustafsson
- Department of Public Health and Clinical Medicine; Family Medicine; Umeå University; Umeå Sweden
| | - PA Gustafsson
- Faculty of Health Sciences; Department of Clinical and Experimental Medicine; Division of Child and Adolescent Psychiatry; Linköping University; Linköping Sweden
| | - N Nelson
- Faculty of Health Sciences; Department of Clinical and Experimental Medicine; Division of Pediatrics; Linköping University; Linköping Sweden
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30
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Gathercole LL, Lavery GG, Morgan SA, Cooper MS, Sinclair AJ, Tomlinson JW, Stewart PM. 11β-Hydroxysteroid dehydrogenase 1: translational and therapeutic aspects. Endocr Rev 2013; 34:525-55. [PMID: 23612224 DOI: 10.1210/er.2012-1050] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) interconverts the inactive glucocorticoid cortisone and its active form cortisol. It is widely expressed and, although bidirectional, in vivo it functions predominantly as an oxoreductase, generating active glucocorticoid. This allows glucocorticoid receptor activation to be regulated at a prereceptor level in a tissue-specific manner. In this review, we will discuss the enzymology and molecular biology of 11β-HSD1 and the molecular basis of cortisone reductase deficiencies. We will also address how altered 11β-HSD1 activity has been implicated in a number of disease states, and we will explore its role in the physiology and pathologies of different tissues. Finally, we will address the current status of selective 11β-HSD1 inhibitors that are in development and being tested in phase II trials for patients with the metabolic syndrome. Although the data are preliminary, therapeutic inhibition of 11β-HSD1 is also an exciting prospect for the treatment of a variety of other disorders such as osteoporosis, glaucoma, intracranial hypertension, and cognitive decline.
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Affiliation(s)
- Laura L Gathercole
- School of Clinical and Experimental Medicine, University of Birmingham, Queen Elizabeth Hospital, Edgbaston B15 2TH, United Kingdom
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31
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Lee MJ, Pramyothin P, Karastergiou K, Fried SK. Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity. Biochim Biophys Acta Mol Basis Dis 2013; 1842:473-81. [PMID: 23735216 DOI: 10.1016/j.bbadis.2013.05.029] [Citation(s) in RCA: 239] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 05/18/2013] [Accepted: 05/24/2013] [Indexed: 12/31/2022]
Abstract
Central obesity is associated with insulin resistance and dyslipidemia. Thus, the mechanisms that control fat distribution and its impact on systemic metabolism have importance for understanding the risk for diabetes and cardiovascular disease. Hypercortisolemia at the systemic (Cushing's syndrome) or local levels (due to adipose-specific overproduction via 11β-hydroxysteroid dehydrogenase 1) results in the preferential expansion of central, especially visceral fat depots. At the same time, peripheral subcutaneous depots can become depleted. The biochemical and molecular mechanisms underlying the depot-specific actions of glucocorticoids (GCs) on adipose tissue function remain poorly understood. GCs exert pleiotropic effects on adipocyte metabolic, endocrine and immune functions, and dampen adipose tissue inflammation. GCs also regulate multiple steps in the process of adipogenesis. Acting synergistically with insulin, GCs increase the expression of numerous genes involved in fat deposition. Variable effects of GC on lipolysis are reported, and GC can improve or impair insulin action depending on the experimental conditions. Thus, the net effect of GC on fat storage appears to depend on the physiologic context. The preferential effects of GC on visceral adipose tissue have been linked to higher cortisol production and glucocorticoid receptor expression, but the molecular details of the depot-dependent actions of GCs are only beginning to be understood. In addition, increasing evidence underlines the importance of circadian variations in GCs in relationship to the timing of meals for determining their anabolic actions on the adipocyte. In summary, although the molecular mechanisms remain to be fully elucidated, there is increasing evidence that GCs have multiple, depot-dependent effects on adipocyte gene expression and metabolism that promote central fat deposition. This article is part of a Special Issue entitled: Modulation of Adipose Tissue in Health and Disease.
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Affiliation(s)
- Mi-Jeong Lee
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Pornpoj Pramyothin
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kalypso Karastergiou
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Susan K Fried
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA.
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Torricelli M, Voltolini C, Conti N, Bocchi C, Severi FM, Petraglia F. Weight gain regardless of pre-pregnancy BMI and influence of fetal gender in response to labor induction in postdate pregnancy. J Matern Fetal Neonatal Med 2013; 26:1016-9. [DOI: 10.3109/14767058.2013.766712] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abraham SB, Rubino D, Sinaii N, Ramsey S, Nieman LK. Cortisol, obesity, and the metabolic syndrome: a cross-sectional study of obese subjects and review of the literature. Obesity (Silver Spring) 2013; 21:E105-17. [PMID: 23505190 PMCID: PMC3602916 DOI: 10.1002/oby.20083] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 09/04/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Circulating cortisol and psychosocial stress may contribute to the pathogenesis of obesity and metabolic syndrome (MS). To evaluate these relationships, a cross-sectional study of 369 overweight and obese subjects and 60 healthy volunteers was performed and reviewed the previous literature. DESIGN AND METHODS Overweight and obese subjects had at least two other features of Cushing's syndrome. They underwent measurements representing cortisol dynamics (24 h urine cortisol excretion (UFC), bedtime salivary cortisol, 1 mg dexamethasone suppression test) and metabolic parameters (BMI, blood pressure (BP); fasting serum triglycerides, HDL, insulin, and glucose). Subjects also completed the Perceived Stress Scale (PSS). UFC, salivary cortisol, and weight from 60 healthy volunteers were analyzed. RESULTS No subject had Cushing's syndrome. UFC and dexamethasone responses were not associated with BMI or weight. However, salivary cortisol showed a trend to increase as BMI increased (P < 0.0001), and correlated with waist circumference (WC) in men (rs = 0.28, P = 0.02) and systolic BP in women (rs = 0.24, P = 0.0008). Post-dexamethasone cortisol levels were weak to moderately correlated with fasting insulin (rs = -0.31, P = 0.01) and HOMA-IR (rs = -0.31, P = 0.01) in men and systolic (rs = 0.18, P = 0.02) and diastolic BP (rs = 0.20, P = 0.009) in women. PSS results were higher in obese subjects than controls, but were not associated with cortisol or metabolic parameters. As expected, WC correlated with fasting insulin, HOMA-IR, and systolic BP (adjusted for BMI and gender; P < 0.01). Literature showed inconsistent relationships between cortisol and metabolic parameters. CONCLUSION Taken together, these data do not support a strong relationship between systemic cortisol or stress and obesity or MS.
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Affiliation(s)
- S B Abraham
- The Program in Reproductive and Adult Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Lindmark S, Lönn L, Wiklund U, Tufvesson M, Olsson T, Eriksson JW. Dysregulation of the Autonomic Nervous System Can Be a Link between Visceral Adiposity and Insulin Resistance. ACTA ACUST UNITED AC 2012; 13:717-28. [PMID: 15897481 DOI: 10.1038/oby.2005.81] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the interplay among abdominal adipose tissue distribution, the cortisol axis, the autonomic nervous system, and insulin resistance. RESEARCH METHODS AND PROCEDURES Two age-, sex-, and BMI-matched groups were studied. Fifteen subjects were first-degree relatives of patients with type 2 diabetes (R), and 15 had no family history of diabetes (controls, C). A hyperinsulinemic euglycemic clamp, cortisol measurements, and analysis of heart rate variability (HRV) were performed. Computed tomography was performed in a subgroup (n = 9 + 9) to determine abdominal adipose tissue distribution. RESULTS R tended to be less insulin-sensitive than C (M value 9.2 +/- 1.0 vs 10.3 +/- 0.7 mg/kg per minute, not significant). Stimulation with tetracosactin or corticotropin releasing hormone yielded lower peak serum cortisol levels in R (p = 0.03 and p = 0.06, respectively). The amount of visceral abdominal fat (VAT) tended to be greater in R. In all subjects, VAT was negatively correlated to insulin sensitivity (r = -0.93, p < 0.001). There was a positive association between VAT and resting heart rate (r = 0.70, p = 0.003) and sympathetic/parasympathetic ratio in HRV assessment after tilt (r = 0.53, p = 0.03). Subcutaneous abdominal tissue was not associated with insulin sensitivity or any of the hormonal or HRV assessments. DISCUSSION Subjects genetically predisposed for type 2 diabetes had a tendency toward a larger amount of VAT and to lower insulin sensitivity compared with control subjects. The amount of visceral fat was strongly associated with insulin resistance and signs of a high ratio of sympathetic vs. parasympathetic reactivity. A large amount of visceral fat may act in concert with sympathetic/parasympathetic imbalance to promote the development of insulin resistance, and this may be partly independent of genetic background.
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Affiliation(s)
- Stina Lindmark
- Department of Medicine, Umeå University Hospital, S-901 85 Umeå, Sweden.
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Abstract
Adrenal steroidogenesis is under the control of the hypothalamic-pituitary-adrenal (HPA) axis. Furthermore, metabolic factors including insulin and obesity-related signals may play a role in the regulation of both enzymes involved in the steroidogenetic pathways, as well as in the regulation of the HPA axis. In women with the polycystic ovary syndrome (PCOS), cortisol production rate is probably normal, although adrenal androgens can be overproduced in a subset of affected women. Cortisol metabolism and regeneration from inactive glucocorticoids can also be disrupted in PCOS, thereby contributing to determining an adrenal hyperandrogenic state. Finally, overactivity of the HPA axis may be related to the high prevalence of psychopathological and eating disorders in women with PCOS, implying a maladaptive allostatic load in the adaptive mechanisms to chronic stress exposure.
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Affiliation(s)
- Renato Pasquali
- b Division of Endocrinology, Department of Clinical Medicine, University Alma Mater Studiorum, St. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
| | - Alessandra Gambineri
- a Division of Endocrinology, Department of Clinical Medicine, University Alma Mater Studiorum, St. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
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Pasquali R. The hypothalamic-pituitary-adrenal axis and sex hormones in chronic stress and obesity: pathophysiological and clinical aspects. Ann N Y Acad Sci 2012; 1264:20-35. [PMID: 22612409 PMCID: PMC3464358 DOI: 10.1111/j.1749-6632.2012.06569.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Obesity, particularly the abdominal phenotype, has been ascribed to an individual maladaptation to chronic environmental stress exposure mediated by a dysregulation of related neuroendocrine axes. Alterations in the control and action of the hypothalamic-pituitary-adrenal axis play a major role in this context, with the participation of the sympathetic nervous system. The ability to adapt to chronic stress may differ according to sex, with specific pathophysiological events leading to the development of stress-related chronic diseases. This seems to be influenced by the regulatory effects of sex hormones, particularly androgens. Stress may also disrupt the control of feeding, with some differences according to sex. Finally, the amount of experimental data in both animals and humans may help to shed more light on specific phenotypes of obesity, strictly related to the chronic exposure to stress. This challenge may potentially imply a different pathophysiological perspective and, possibly, a specific treatment.
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Affiliation(s)
- Renato Pasquali
- Division of Endocrinology, Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum of Bologna, Bologna, Italy.
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Tyrka AR, Walters OC, Price LH, Anderson GM, Carpenter LL. Altered response to neuroendocrine challenge linked to indices of the metabolic syndrome in healthy adults. Horm Metab Res 2012; 44:543-9. [PMID: 22549400 PMCID: PMC3580172 DOI: 10.1055/s-0032-1306342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Metabolic syndrome (MetS) is characterized by central obesity, hypertension, insulin resistance, and hypercholesterolemia. Hypothalamic-pituitary-adrenal (HPA) axis activity is frequently abnormal in MetS, and excessive cortisol exposure may be implicated in metabolic derangements. We investigated the hypothesis that cortisol and adrenocorticotropic hormone (ACTH) responses to a standardized neuroendocrine challenge test would be associated with indices of MetS in a community sample of healthy adults. Healthy adults, 125 men and 170 women, without significant medical problems or chronic medications were recruited from the community. Participants completed the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test, and anthropometric measurements, blood pressure, glycosylated hemoglobin (HbA1c), and cholesterol were measured. Participants reported on their history of early life stress and recent stress, as well as mood and anxiety symptoms. Cortisol and ACTH responses to the Dex/CRH test were negatively associated with measures of central adiposity (p<0.001) and blood pressure (p<0.01), and positively associated with HDL cholesterol (p<0.01). These findings remained significant after controlling for body mass index (BMI). Measures of stress and anxiety and depressive symptoms were negatively correlated with cortisol and ACTH responses in the Dex/CRH test but were not related to MetS indices. That altered HPA axis function is linked to MetS components even in a healthy community sample suggests that these processes may be involved in the pathogenesis of MetS. Identification of premorbid risk processes might allow for detection and intervention prior to the development of disease.
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Affiliation(s)
- A R Tyrka
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, Rhode Island, USA.
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Golden SH, Wand GS, Malhotra S, Kamel I, Horton K. Reliability of hypothalamic-pituitary-adrenal axis assessment methods for use in population-based studies. Eur J Epidemiol 2011; 26:511-25. [PMID: 21533585 DOI: 10.1007/s10654-011-9585-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 04/12/2011] [Indexed: 01/30/2023]
Abstract
Population-based studies have been hampered in exploring hypothalamic-pituitary-adrenal axis (HPA) activity as a potential explanatory link between stress-related and metabolic disorders due to their lack of incorporation of reliable measures of chronic cortisol exposure. The purpose of this review is to summarize current literature on the reliability of HPA axis measures and to discuss the feasibility of performing them in population-based studies. We identified articles through PubMed using search terms related to cortisol, HPA axis, adrenal imaging, and reliability. The diurnal salivary cortisol curve (generated from multiple salivary samples from awakening to midnight) and 11 p.m. salivary cortisol had the highest between-visit reliabilities (r = 0.63-0.84 and 0.78, respectively). The cortisol awakening response and dexamethasone-suppressed cortisol had the next highest between-visit reliabilities (r = 0.33-0.67 and 0.42-0.66, respectively). Based on our own data, the inter-reader reliability (r(s)) of adrenal gland volume from non-contrast CT was 0.67-0.71 for the left and 0.47-0.70 for the right adrenal glands. While a single 8 a.m. salivary cortisol is one of the easiest measures to perform, it had the lowest between-visit reliability (R = 0.18-0.47). Based on the current literature, use of sampling multiple salivary cortisol measures across the diurnal curve (with awakening cortisol), dexamethasone-suppressed cortisol, and adrenal gland volume are measures of HPA axis tone with similar between-visit reliabilities which likely reflect chronic cortisol burden and are feasible to perform in population-based studies.
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Divari S, Cannizzo FT, Uslenghi F, Pregel P, Mulasso C, Spada F, De Maria R, Biolatti B. Corticosteroid hormone receptors and prereceptors as new biomarkers of the illegal use of glucocorticoids in meat production. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2011; 59:2120-2125. [PMID: 21306119 DOI: 10.1021/jf1044603] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Despite the European ban on the use of growth promoters in cattle, veterinary surveillance reports indicate that the illicit use of corticosteroids persists both alone and in combination with anabolic hormones and β-agonists. Current control strategies should be informed by research into the effects of corticosteroids on bovine metabolism and improved through the development of specific, sensitive diagnostic methods that utilize potential molecular biomarkers of corticosteroid treatment. The actions of corticosteroids on target tissues are principally regulated by two receptors: the glucocorticoid receptor (GR) and the mineralocorticoid receptor (MR). The effects of these steroids are modulated by prereceptor enzyme-mediated metabolism: the two isoforms of the 11β-hydroxysteroid dehydrogenase (11β-HSDs) enzyme catalyze the interconversion between active glucocorticoids, such as cortisol, into inactive compounds, such as cortisone. This study aimed to determine whether the expression of the prereceptor system and of the corticosteroid receptors could be regulated in different target tissues by the administration of dexamethasone and prednisolone in cattle. It was observed that greater up-regulation of the GR and MR genes followed dexamethasone treatment in the muscle tissues than in the kidney, liver, and salivary glands; up-regulation of GR and MR expression following prednisolone treatment was higher in adipose tissue than in the other tissues. The thymus seemed to respond to dexamethasone treatment but not to prednisolone treatment. Both treatments significantly down-regulated 11β-HSD2 gene expression in the adrenal tissues, but only dexamethasone treatment down-regulated 11β-HSD2 expression in the bulbourethral and prostate glands. Together, these data indicate that the combination of GR, MR, and 11β-HSD2 could provide a useful biomarker system to detect the use of illicit glucocorticoid treatment in cattle.
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Affiliation(s)
- Sara Divari
- Dipartimento di Patologia Animale, Università di Torino , Via Leonardo da Vinci 44, 10095 Grugliasco (TO), Italy.
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Daubenmier J, Kristeller J, Hecht FM, Maninger N, Kuwata M, Jhaveri K, Lustig RH, Kemeny M, Karan L, Epel E. Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study. J Obes 2011; 2011:651936. [PMID: 21977314 PMCID: PMC3184496 DOI: 10.1155/2011/651936] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/01/2011] [Indexed: 11/18/2022] Open
Abstract
Psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the Metabolic Syndrome. Effects of stress reduction interventions on abdominal fat are unknown. Forty-seven overweight/obese women (mean BMI = 31.2) were randomly assigned to a 4-month intervention or waitlist group to explore effects of a mindfulness program for stress eating. We assessed mindfulness, psychological distress, eating behavior, weight, cortisol awakening response (CAR), and abdominal fat (by dual-energy X-ray absorptiometry) pre- and posttreatment. Treatment participants improved in mindfulness, anxiety, and external-based eating compared to control participants. Groups did not differ on average CAR, weight, or abdominal fat over time. However, obese treatment participants showed significant reductions in CAR and maintained body weight, while obese control participants had stable CAR and gained weight. Improvements in mindfulness, chronic stress, and CAR were associated with reductions in abdominal fat. This proof of concept study suggests that mindfulness training shows promise for improving eating patterns and the CAR, which may reduce abdominal fat over time.
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Affiliation(s)
- Jennifer Daubenmier
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
- *Jennifer Daubenmier: and
| | - Jean Kristeller
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
| | - Frederick M. Hecht
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
| | - Nicole Maninger
- California National Primate Research Center, University of California, Davis, CA 95616, USA
| | - Margaret Kuwata
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
| | - Kinnari Jhaveri
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
| | - Robert H. Lustig
- Department of Pediatrics, University of California, San Francisco, CA 94143, USA
| | - Margaret Kemeny
- Department of Psychiatry, University of California, San Francisco, CA 94143, USA
| | - Lori Karan
- Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, CA 94143, USA
- *Elissa Epel:
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Reynolds RM. Corticosteroid-mediated programming and the pathogenesis of obesity and diabetes. J Steroid Biochem Mol Biol 2010; 122:3-9. [PMID: 20117209 DOI: 10.1016/j.jsbmb.2010.01.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 12/21/2009] [Accepted: 01/20/2010] [Indexed: 01/23/2023]
Abstract
Epidemiological studies have shown that low birthweight is associated with increased risk of development of diabetes and obesity in later life. Over-exposure of the developing fetus to glucocorticoids is one of the major hypotheses that has been proposed to explain this association. In animal models, a range of manipulations that increase fetal glucocorticoid load, 'programme' permanent changes in glucose and insulin metabolism and adiposity. This may be mediated by alterations in regulation of the hypothalamic-pituitary-adrenal (HPA) axis. In humans, low birthweight is associated with increased circulating glucocorticoid levels, and an increased cortisol response to physiological and psychosocial stressors, in child- and adulthood. This activation of the HPA axis is also associated with increased risk of development of diabetes and obesity in later life.
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Affiliation(s)
- Rebecca M Reynolds
- Endocrinology Unit, Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
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Gathercole LL, Stewart PM. Targeting the pre-receptor metabolism of cortisol as a novel therapy in obesity and diabetes. J Steroid Biochem Mol Biol 2010; 122:21-7. [PMID: 20347978 DOI: 10.1016/j.jsbmb.2010.03.060] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/07/2010] [Accepted: 03/21/2010] [Indexed: 01/08/2023]
Abstract
Due to its impact upon health and the economy, the mechanisms that contribute to the pathogenesis of obesity and the metabolic syndrome are under intense scrutiny. In addition to understanding the pathogenesis of disease it is important to design and trial novel therapies. Patients with cortisol excess, Cushing's syndrome, have a phenotype similar to that of the metabolic syndrome and as a result there is much interest the manipulation of glucocorticoid (GC) action as a therapeutic strategy. Intracellular GC levels are regulated by 11β-hydroxysteroid dehydrogenase (11β-HSD1) which converts inactive cortisone to cortisol, thereby increasing local GC action. There is an abundance of data implicating 11β-HSD1 in the pathogenesis of obesity, type 2 diabetes and the metabolic syndrome and 11β-HSD1 is an attractive therapeutic target. Selective 11β-HSD1 inhibitors, which do not act upon 11β-HSD2 (which inactivates cortisol to cortisone) are in development. So far studies have primarily been carried out in rodents, with results showing improvements in metabolic profile. Data are now beginning to emerge from human studies and the results are promising.
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Affiliation(s)
- Laura L Gathercole
- School of Clinical and Experimental Medicine, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Rutters F, Nieuwenhuizen AG, Lemmens SGT, Born JM, Westerterp-Plantenga MS. Hypothalamic-pituitary-adrenal (HPA) axis functioning in relation to body fat distribution. Clin Endocrinol (Oxf) 2010; 72:738-43. [PMID: 19769618 DOI: 10.1111/j.1365-2265.2009.03712.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To relate hypothalamic-pituitary-adrenal (HPA) axis functioning and HPA feedback functioning to body fat distribution in normal weight to obese subjects. PATIENTS 91 men and 103 women [age 18-45 years, BMI 19-35 kg/m(2), waist-to-hip ratio (WHR) 0.6-1.1]. MEASUREMENTS Anthropometry, body composition using hydrodensitometry and deuterium dilution method, cortisol variability by measuring 5-h cortisol concentrations, HPA axis feedback functioning using a dexamethasone suppression test, and HPA axis functioning under a challenged condition consisting of a standardized high-intensity test with ingestion of 4 mg dexamethasone. RESULTS In men, an inverse relationship was observed between 5-h cortisol exposure (nmol/ml) and fat mass index (FMI) (kg/m(2)) (r = -0.55, P < 0.001). In women, relationships were observed between 5-h cortisol exposure (nmol/ml.min) and WHR (r = -0.49, P < 0.001), maximal workload (r = 0.32, P < 0.001) as well as oral contraceptive use (r = 0.38, P < 0.001). Similarly, in men, an inverse relationship was observed between negative feedback expressed as baseline concentrations minus post dexamethasone cortisol concentrations (nmol/ml) and FMI (r = -0.53, P < 0.001). In women, relationships were observed between negative feedback expressed as baseline concentrations minus post dexamethasone cortisol concentrations (nmol/ml) and WHR (r = -0.43, P < 0.001), maximal workload (r = 0.30, P < 0.001) as well as oral contraceptive use (r = 0.43, P < 0.001) in women. Moreover, an inverse relationship was observed between HPA axis functioning in a challenged condition expressed as percentage increase of cortisol concentrations after standardized high-intensity test with ingestion of 4 mg dexamethasone (%) and waist circumference (r = -0.21, P < 0.10) in men and WHR (r = -0.21, P < 0.05) in women. In men, strong positive relationships were observed between FMI and waist circumference (r = 0.85, P < 0.001), as well as waist-to-hip ratio (r = 0.70, P < 0.001). CONCLUSION Disturbance of HPA axis functioning under basal and challenged conditions is related to visceral fat accumulation.
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Affiliation(s)
- Femke Rutters
- Department of Human Biology, Maastricht University, Maastricht, The Netherlands.
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Boyle CD, Kowalski TJ. 11beta-hydroxysteroid dehydrogenase type 1 inhibitors: a review of recent patents. Expert Opin Ther Pat 2009; 19:801-25. [PMID: 19456274 DOI: 10.1517/13543770902967658] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The main components of metabolic syndrome (obesity, insulin resistance, hypertension and dyslipidemia) have become prevalent worldwide, and excess glucocorticoid levels have been implicated in patients with these symptoms. 11beta-Hydroxysteroid dehydrogenase type 1 (11beta-HSD1) is an enzyme involved in glucocorticoid regulation through catalysis of the conversion of inactive cortisone to its active form cortisol. Numerous rodent studies have demonstrated the potential use of 11beta-HSD1 inhibitors as treatment for the components of metabolic syndrome and limited clinical data in humans have shown 11beta-HSD1 inhibition to improve glucose levels, insulin sensitivity and lipid profiles. Many organizations have been active in the 11beta-HSD1 academic and patent literature, and two previous articles from this journal have reviewed disclosures through August 2007. OBJECTIVE To summarize the recent patent literature and progress in defining the utility of small molecule 11beta-HSD1 inhibitors. METHODS This review covers the recent 11beta-HSD1 patent literature and clinical activity ranging from late 2007 through the end of 2008. RESULTS/CONCLUSION The exploration of 11beta-HSD1 inhibitors continues, as a number of structural classes have been reported by several pharmaceutical companies over the past 16 months. Current clinical trials will ultimately shed light on the feasibility of 11beta-HSD1 inhibitors as pharmaceutical agents for the various components of metabolic syndrome.
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Affiliation(s)
- Craig D Boyle
- CNS and CV/Metabolic Chemical Research, Schering-Plough Research Institute, 2015 Galloping Hill Road, K-15-2-2545, Kenilworth, NJ 07033-1300, USA.
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Larsson CA, Gullberg B, Råstam L, Lindblad U. Salivary cortisol differs with age and sex and shows inverse associations with WHR in Swedish women: a cross-sectional study. BMC Endocr Disord 2009; 9:16. [PMID: 19545400 PMCID: PMC2711063 DOI: 10.1186/1472-6823-9-16] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 06/21/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Most studies on cortisol have focused on smaller, selected samples. We therefore aimed to sex-specifically study the diurnal cortisol pattern and explore its association with abdominal obesity in a large unselected population. METHODS In 2001-2004, 1811 men and women (30-75 years) were randomly selected from the Vara population, south-western Sweden (81% participation rate). Of these, 1671 subjects with full information on basal morning and evening salivary cortisol and anthropometric measurements were included in this cross-sectional study. Differences between groups were examined by general linear model and by logistic and linear regression analyses. RESULTS Morning and Delta-cortisol (morning - evening cortisol) were significantly higher in women than men. In both genders older age was significantly associated with higher levels of all cortisol measures, however, most consistently with evening cortisol. In women only, age-adjusted means of WHR were significantly lower in the highest compared to the lowest quartile of morning cortisol (p = 0.036) and Delta-cortisol (p < 0.001), respectively. Furthermore, when comparing WHR above and below the mean, the age-adjusted OR in women for the lowest quartile of cortisol compared to the highest was 1.5 (1.0-2.2, p = 0.058) for morning cortisol and 1.9 (1.3-2.8) for Delta-cortisol. All findings for Delta-cortisol remained after adjustments for multiple covariates and were also seen in a linear regression analysis (p = 0.003). CONCLUSION In summary, our findings of generally higher cortisol levels in women than men of all ages are novel and the stronger results seen for Delta-cortisol as opposed to morning cortisol in the association with WHR emphasise the need of studying cortisol variation intra-individually. To our knowledge, the associations in this study have never before been investigated in such a large population sample of both men and women. Our results therefore offer important knowledge on the descriptive characteristics of cortisol in relation to age and gender, and on the impact that associations previously seen between cortisol and abdominal obesity in smaller, selected samples have on a population level.
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Affiliation(s)
- Charlotte A Larsson
- University of Lund, Department of Clinical Sciences, Malmö, Community Medicine, Malmö, Sweden
| | - Bo Gullberg
- University of Lund, Department of Clinical Sciences, Malmö, Community Medicine, Malmö, Sweden
| | - Lennart Råstam
- University of Lund, Department of Clinical Sciences, Malmö, Community Medicine, Malmö, Sweden
| | - Ulf Lindblad
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Skaraborg Institute, Skövde, Sweden
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Mattsson C, Reynolds RM, Simonyte K, Olsson T, Walker BR. Combined receptor antagonist stimulation of the hypothalamic-pituitary-adrenal axis test identifies impaired negative feedback sensitivity to cortisol in obese men. J Clin Endocrinol Metab 2009; 94:1347-52. [PMID: 19141586 DOI: 10.1210/jc.2008-2054] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Hypothalamic-pituitary-adrenal (HPA) axis dysregulation may underlie disorders including obesity, depression, cognitive decline, and the metabolic syndrome. Conventional tests of HPA axis negative feedback rely on glucocorticoid receptor (GR) agonists such as dexamethasone but do not test feedback by endogenous cortisol, potentially mediated by both GR and mineralocorticoid receptors (MR). OBJECTIVE The objective of the study was to use a combination of GR (RU38486, mifepristone) and MR (spironolactone) antagonists to explore the poorly understood activation of the HPA axis that occurs in obesity. DESIGN This was a double-blind, placebo-controlled, randomized, crossover study. SETTING The study was conducted at a clinical research facility. PARTICIPANTS Participants included 15 lean (body mass index 22.0 +/- 1.6 kg/m(2)) and 16 overweight/obese (body mass index 30.1 +/- 3.5 kg/m(2)) men. INTERVENTION Subjects attended on four occasions for blood and saliva sampling every 30 min between 1800 and 2200 h. At 1100 and 1600 h before visits, subjects took 200 mg spironolactone, 400 mg RU38486, 200 mg spironolactone + 400 mg RU38486, or placebo orally. MAIN OUTCOME MEASURES Serum cortisol levels after drug or placebo were measured. RESULTS Cortisol levels did not differ between lean and obese after placebo. Spironolactone and RU38486 alone had modest effects, increasing cortisol by less than 50% in both groups. However, combined spironolactone plus RU38486 elevated cortisol concentrations substantially, more so in lean than obese men [2.9- (0.3) vs. 2.2 (0.3)-fold elevation, P = 0.002]. CONCLUSIONS Combined receptor antagonist stimulation of the HPA axis reveals redundancy of MR and GR in negative feedback in humans. Obese men have impaired responses to combined receptor antagonist stimulation, suggesting impaired negative feedback by endogenous cortisol. Such an approach may be useful to dissect abnormal HPA axis control in neuropsychiatric and other disorders.
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Affiliation(s)
- Cecilia Mattsson
- Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden
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Cercato C, Halpern A, Frazzatto EST, Guazzelli IC, Villares SMF. The N363S polymorphism in the glucocorticoid receptor gene: effects on visceral fat assessed by abdominal computed tomography. ACTA ACUST UNITED AC 2009; 53:288-92. [DOI: 10.1590/s0004-27302009000200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 02/16/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To verify whether N363S polymorphism of the glucocorticoid receptor-gene can be associated to visceral fat by CT scan in obese individuals, and the impact of this variant on metabolic profile. METHODS: The N363S variant was screened in 295 Brazilians, 195 were obese and 100 presented normal weight. Based on genotype, obese N363S SNP carriers were paired with obese wild-type subjects. This group was submitted to a CT scan and metabolic profile assessment. RESULTS: Ten subjects were found to be heterozygous for the variant (A/G genotype frequency 3.4%), 8 (4.1%) obese and 2 (2.0%) non-obese. No differences were reported for visceral adiposity area (145.8 ± 49.9 vs.147.7 ± 48.8 cm²; p = 0.92) based on CT scan results but N363S SNP carriers showed a proneness to unfavorable metabolic changes. CONCLUSION: The N363S polymorphism prevalence is low in the Brazilian population, although its presence may contribute to the worsening of individuals' metabolic profiles.
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Abstract
The nature of the relationship between affective disorders, bone mineral density (BMD), and bone metabolism is unresolved, although there is growing evidence that many medications used to treat affective disorders are associated with low BMD or alterations in neuroendocrine systems that influence bone turnover. The objective of this review is to describe the current evidence regarding the association of unipolar and bipolar depression with BMD and indicators of bone metabolism, and to explore potential mediating and confounding influences of those relationships. The majority of studies of unipolar depression and BMD indicate that depressive symptoms are associated with low BMD. In contrast, evidence regarding the relationship between bipolar depression and BMD is inconsistent. There is limited but suggestive evidence to support an association between affective disorders and some markers of bone turnover. Many medications used to treat affective disorders have effects on physiologic systems that influence bone metabolism, and these conditions are also associated with a range of health behaviors that can influence osteoporosis risk. Future research should focus on disentangling the pathways linking psychotropic medications and their clinical indications with BMD and fracture risk.
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Affiliation(s)
- Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory, 3644 SPH Tower, Ann Arbor, MI 48109, USA
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Batista DL, Courcoutsakis N, Riar J, Keil MF, Stratakis CA. Severe obesity confounds the interpretation of low-dose dexamethasone test combined with the administration of ovine corticotrophin-releasing hormone in childhood Cushing syndrome. J Clin Endocrinol Metab 2008; 93:4323-30. [PMID: 18728165 PMCID: PMC2582576 DOI: 10.1210/jc.2008-0985] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Suppression of cortisol secretion with a low-dose dexamethasone (Dex) followed by the administration of ovine CRH (Dex-oCRH) is used in the evaluation of adults with a pseudo-Cushing syndrome state (PCSS) vs. Cushing syndrome (CS). OBJECTIVE The aim of the study was to determine the value of Dex-oCRH testing in the investigation of childhood CS. DESIGN We conducted a retrospective analysis of data from children evaluated for CS vs. PCSS from 1998-2006; body mass index Z (BMIZ) and height-for-age Z (HAZ) scores were estimated. SETTING A clinical research center was the setting for the study. MAIN OUTCOME MEASURES The main outcomes were confirmation of the diagnosis of CS by histology and response to Dex-oCRH. RESULTS Thirty-two children (ages 3-17 yr) were studied: 11 had CS and 21 had PCSS; of the latter, 11 had a BMIZ score greater than 2. Children with CS had a mean HAZ score of -1.3+/-0.51 vs. 0.31+/-0.38 in nonobese and 0.71+/-0.39 in obese children (P<0.001). The previously established criterion of a cortisol of 1.4 microg/dl (38 nmol/liter) after Dex-oCRH identified all 10 normal children who were not very obese and those with CS; 5 of 11 normal children with more severe obesity had cortisol values greater than 1.4 microg/dl (38 nmol/liter) after Dex-oCRH, lowering the test specificity to 55%. Without consideration for obesity, an increase of the cutoff cortisol value after Dex-oCRH to 3.2 microg/dl (88 nmol/liter) will have 91% sensitivity and 95% specificity; the corresponding values for a cutoff of 2.2 microg/dl (61 nmol/liter) were 100 and 90.5%, respectively. CONCLUSION Our study showed that height gain is a simple way of distinguishing children with PCCS from those with CS; the interpretation of Dex-oCRH in children is confounded by severe obesity, which limits the utility of this test.
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Affiliation(s)
- Dalia L Batista
- Section on Endocrinology and Genetics, Program in Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA
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Wirtz PH, Ehlert U, Emini L, Suter T. Higher body mass index (BMI) is associated with reduced glucocorticoid inhibition of inflammatory cytokine production following acute psychosocial stress in men. Psychoneuroendocrinology 2008; 33:1102-10. [PMID: 18644679 DOI: 10.1016/j.psyneuen.2008.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 04/21/2008] [Accepted: 05/23/2008] [Indexed: 12/23/2022]
Abstract
BACKGROUND Body mass index (BMI) and mental stress seem to exert part of their cardiovascular risk by eliciting inflammation. However, the adverse effects of stress on inflammatory activity with BMI are not fully understood. We investigated whether higher BMI is associated with reduced glucocorticoid inhibition of inflammatory cytokine production following stress in men while controlling for age and blood pressure. We measured glucocorticoid inhibition of lipopolysaccharide (LPS)-stimulated release of the proinflammatory cytokine tumor necrosis factor (TNF)-alpha. METHODS Forty-two men (age range 21-65 years; BMI range 21-34 kg/m(2)) underwent the Trier Social Stress Test (combination of mock job interview and mental arithmetic task). Whole blood samples were taken immediately before and after stress, and during recovery up to 60 min post-stress. Glucocorticoid sensitivity of LPS-stimulated TNF-alpha expression was assessed in vitro with and without coincubating increasing doses of dexamethasone. Moreover, salivary cortisol was measured during the experiment and on a normal day for assessment of baseline circadian cortisol. RESULTS Higher BMI was associated with lower glucocorticoid sensitivity of monocyte TNF-alpha production after stress (main effect of BMI: p<0.001) and with more pronounced decreases of glucocorticoid sensitivity following stress (interaction of stress-by-BMI: p=0.002). Neither LPS-stimulated TNF-alpha release nor baseline glucocorticoid sensitivity were associated with BMI. Similarly, BMI was not associated with salivary cortisol, either in reaction to stress or in circadian cortisol secretion. CONCLUSIONS Our data suggest that with increasing BMI, glucocorticoids are less able to inhibit TNF-alpha production following stress. This might suggest a new mechanism linking BMI with elevated risk for adverse cardiovascular outcomes following stress.
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Affiliation(s)
- Petra H Wirtz
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Switzerland.
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