(12-10-14) Relationships between 24-hour urinary free cortisol concentrations and

Reinehr T1, Kulle A, Wolters B, Knop C, Lass N, Welzel M, Holterhus PM.
Author information

Abstract
CONTEXT:
Clinical features of Metabolic Syndrome (MetS) and Cushing's Syndrome are
similar, suggesting a pathogenetic role of hypothalamus-pituitary-adrenal axis
in MetS.
OBJECTIVE:
The aim of the study was to determine whether MetS diagnosis and specific
clusters of MetS components (waist circumference, dyslipidemia, hypertension,
and impaired glucose metabolism) are associated with serum cortisol (SC) or 24-
h urinary free cortisol (UFC) levels.
DESIGN AND SETTING:
We conducted cross-sectional analyses of data from our obesity cohort. We
studied 264 obese children (age, 11.0 ± 2.8 years; male, 48%; BMI, 28.2 ± 5.4
kg/m(2)). We examined UFC, SC, homeostasis model assessment (HOMA), and
features of MetS (waist circumference, blood pressure, fasting lipids, and
glucose).
RESULTS:
Slightly increased UFC concentrations were measured in 30.7% of the children.
Obese children with MetS had significantly (P = .003) higher UFC levels
compared with obese children without MetS. Girls demonstrated significantly
higher UFC concentrations compared with boys independent of pubertal stage. UFC
and SC levels were significantly related to features of MetS, but the
associations were stronger for UFC. In multivariate analyses adjusted for age,
sex, and body mass index, none of the features of MetS but HOMA index was
correlated with UFC, whereas SC demonstrated no significant association to any
parameter of MetS or HOMA.
CONCLUSIONS:
Our findings support the hypothesis that changes in the hypothalamus-pituitary-
adrenal axis are related to MetS in obesity. UFC seems to be a suitable marker
for this relationship. Norm values for UFC adapted to obese children may help
to avoid unnecessary dexamethasone suppression tests.

Source: J Clin Endocrinol Metab. 2014 Jul;99(7):2391-9. doi: 10.1210/jc.2013-4398. Epub
2014 Mar 26.

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