Depression differed by midnight cortisol secretion, alexithymia and anxiety between diabetes types: a cross sectional comparison

Adolescence is associated with an increase in the rate of certain psychiatric symptoms, and it is typically the developmental period when prodromal features of the major psychiatric disorders emerge. This is especially true of schizophrenia, with the majority of patients showing a marked postpubertal rise in schizotypal signs that predates the onset of clinical symptoms in early adulthood. Cross-sectional studies of youth have revealed a positive correlation between age and saliva cortisol level, suggesting a normative maturational increase in activity of the hypothalamic–pituitary–adrenal (HPA) axis. It has been hypothesized that this increase may trigger the expression of symptoms in vulnerable individuals. The present longitudinal study measured cortisol secretion and its relation with symptom development in samples of youth with schizotypal personality disorder (SPD), other personality disorders, or no Axis II disorder. The findings indicate moderate stability in cortisol levels across a 2-year period, with a longitudinal increase in cortisol levels over time. Cortisol levels at the first and second assessments were correlated with the severity of SPD symptoms at follow-up. The results are consistent with the notion that the HPA axis undergoes a postpubertal maturational process that moderates the expression of psychiatric symptoms.

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Abnormal body composition in patients with adrenal adenomas

Acta Endocrinologica ◽

10.1530/eje-21-0458 ◽

2021 ◽

Author(s):

Danae Delivanis ◽

Maria Daniela Hurtado Andrade ◽

Tiffany Cortes ◽

Shobana Athimulam ◽

Aakanksha Khanna ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Muscle Mass ◽

Visceral Fat ◽

Cushing Syndrome ◽

Cross Sectional Study ◽

Cortisol Secretion ◽

Muscle Area ◽

Cross Sectional ◽

Skeletal Muscle Area

Objective: Increased visceral fat and sarcopenia are cardiovascular risk factors that may explain increased cardiovascular morbidity and frailty in patients with adrenal adenomas. Our objective was to compare body composition measurement of patients with adrenal adenomas to referent subjects without adrenal disease Design: Cross-sectional study, 2014-2018 Methods: Participants were adults with nonfunctioning adrenal tumor (NFAT), mild autonomous cortisol secretion (MACS) and Cushing syndrome (CS), and age, sex and body mass index 1:1 matched referent subjects without adrenal disorders. Main outcome measures were body composition measurements calculated from abdominal computed tomography imaging. Intraabdominal adipose tissue and muscle mass measurements were performed at the 3rd lumbar spine level. Results: Of 227 patients with adrenal adenomas, 20 were diagnosed with CS, 76 with MACS and 131 with NFAT. Median age was 56 years (range, 18-89), and 67% were women. When compared to referent subjects, patients with CS, MACS, and NFAT demonstrated a higher visceral fat (odds ratio (OR) of 2.2 [95% CI 0.9-6.5], 2.0 [1.3-3.2], and 1.8 [1.2-2.7] and a lower skeletal muscle area (OR of 0.01 [95% CI 0-0.09], 0.31 [0.18-0.49], and 0.3 [1.2-2.7]), respectively. For every 1 mcg/dL cortisol increase after overnight dexamethasone, visceral fat/muscle area ratio increased by 2.3 (P=0.02) and mean total skeletal muscle area decreased by 2.2cm2 (P=0.03). Conclusion: Patients with adrenal adenomas demonstrate a lower muscle mass and a higher proportion of visceral fat when compared to referent subjects, including patients with NFAT. Even a subtle abnormality in cortisol secretion may impact health of patients with adenomas.

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Midnight salivary cortisol secretion and the use of antidepressants were associated with abdominal obesity in women with type 1 diabetes: a cross sectional study

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-019-0481-3 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Eva Olga Melin ◽

Magnus Hillman ◽

Maria Thunander ◽

Mona Landin-Olsson

Keyword(s):

Type 1 Diabetes ◽

Logistic Regression ◽

Abdominal Obesity ◽

Salivary Cortisol ◽

Cross Sectional Study ◽

Cortisol Secretion ◽

Multiple Logistic Regression ◽

Sectional Study ◽

Cross Sectional

Abstract Background Abdominal obesity is a risk factor for cardiovascular disease. The aim was to explore the influence of midnight salivary cortisol (MSC), antidepressants and sex on abdominal obesity in type 1 diabetes (T1D). We controlled for physical inactivity, smoking, depression and alexithymia. Methods Cross sectional study of 190 T1D patients (86 women/104 men, 18–59 years, diabetes duration 1–55 years), consecutively recruited from one specialist diabetes outpatient clinic. Anthropometrics, blood pressure, saliva and blood samples were collected, supplemented with data from electronic medical records. Depression and alexithymia were assessed by self-report instruments. MSC (nmol/l) was categorised into 3 levels: high MSC: (≥ 6.7) (n = 64); intermediate MSC: ≥ 3.7− < 6.7) (n = 64); low MSC (< 3.7) (n = 62). Abdominal obesity was defined as waist circumference (meters) ≥ 0.88 for women and as ≥ 1.02 for men. Multiple logistic regression analyses (Backward: Wald) were performed. The Hosmer and Lemeshow test for goodness-of-fit and Nagelkerke R2 were used to evaluate each multiple logistic regression analysis model. Results The prevalence of abdominal obesity was three times higher in the women than in the men (24% versus 8%) (p = 0.002). Antidepressants were used by 10% of the women and by 4% of the men (p = 0.09). The prevalence of high MSC was 1.7 times higher in the women (43% versus 26%); the prevalence of both intermediate MSC (28% versus 38%) and low MSC (29% versus 36%) were lower in the women (p = 0.048). Significant associations with abdominal obesity were for all 190 patients: female sex (adjusted odds ratio (AOR) 3.4 (confidence interval (CI) 1.4–8.2)) and the use of antidepressants (AOR 4.3 (CI 1.2–14.8)); for the 86 women: high MSC (AOR 18.4 (CI 1.9–181)) and use of antidepressants (AOR 12.2 (CI 2.0–73.6)); and for the 104 men: alexithymia (AOR 5.2 (CI 1.1–24.9)). Conclusions Clear sex differences were demonstrated with a distinct higher prevalence of abdominal obesity, as well as a distinct higher prevalence of high midnight salivary cortisol in the women with type 1 diabetes. High midnight salivary cortisol secretion and the use of antidepressants were independent risk factors for abdominal obesity in the women.

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Cortisol secretion pattern in overweight/obese and normal-weight infants: a cross-sectional study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0273 ◽

2020 ◽

Vol 33 (2) ◽

pp. 241-246

Author(s):

Ana Cristina Resende Camargos ◽

Pedro Henrique Scheidt Figueiredo ◽

Sueli Ferreira da Fonseca ◽

Mariana Aguiar de Matos ◽

Katherine Simone Caires Oliveira ◽

...

Keyword(s):

Salivary Cortisol ◽

Area Under The Curve ◽

Cross Sectional Study ◽

Normal Weight ◽

Control Group ◽

Cortisol Secretion ◽

Cross Sectional ◽

Increased Risk ◽

Highly Sensitive ◽

Cortisol Levels

AbstractBackgroundThe salivary circadian diurnal cortisol plays an important role in growth and development. Inappropriate levels may induce changes associated with an increased risk of obesity later in life. It is unknown if there are differences in cortisol secretion pattern between overweight/obese infants when compared with theirs peers in infancy. Thus, this study aimed to compare the salivary cortisol secretion pattern in overweight/obese and normal-weight infants.MethodsThirty-three (overweight/obese = 17 and normal weight = 16) infants between 6 and 24 months of age had saliva samples collected upon awakening (T1), 30 min after waking (T2), at 12:00 am or before the baby’s meal (T3), and prior to bedtime (T4). Highly sensitive enzyme immunoassays were used for cortisol analyses.ResultsSalivary cortisol levels were similar between the groups: T1 (p = 0.22; 95% confidence interval [CI]: −5.65, 1.37), T2 (p = 0.24; 95% CI: −8.23, 2.17), T3 (p = 0.95; 95% CI: −3.16, 2.96), and T4 (p = 0.81; 95% CI: −1.39, 1.08); and no differences were observed between area under the curve (AUC) (p = 0.80; 95% CI: −4.58–13.66). The cortisol level reduced in T4 (95% CI: 1.35–2.96) compared to T1 (95% CI: 5.15–8.49) and T2 in the overweight/obese group (p < 0.001; 95% CI: 6.02–11.04). In the normal-weight group, the cortisol reduced in T3 (95% CI: 2.86–8.18) compared to T1 (95% CI: 5.64–12.28) and decreased until T4 (p = 0.001; 95% CI: 1.25–3.37).ConclusionsThe overweight/obese infant group presented a different pattern of cortisol secretion, although cortisol levels did not differ between the control group.

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Assessment of Plasma-Free Cortisol Concentrations by LC-MS/MS in Patients with Autonomous Cortisol Secretion

Hormone and Metabolic Research ◽

10.1055/a-1661-4126 ◽

2021 ◽

Vol 53 (11) ◽

pp. 752-758

Author(s):

Serkan Yener ◽

Gamze Tuna ◽

Melis Kant ◽

Merve Akis ◽

Ozlem Kara ◽

...

Keyword(s):

Metabolic Profile ◽

Smoking Habit ◽

Free Fraction ◽

Adrenal Incidentaloma ◽

Serum Cortisol ◽

Total Serum ◽

Cortisol Secretion ◽

Cross Sectional ◽

Free Cortisol ◽

Autonomous Cortisol Secretion

AbstractAutonomous cortisol secretion (ACS) of an adrenal incidentaloma (AI) is associated with mild cortisol excess that could result in poor metabolic and cardiovascular outcomes. The biological activity of glucocorticoids depends on the unbound, free fraction. We aimed to evaluate plasma free cortisol (FC) concentrations in patients with ACS in this cross-sectional study. One hundred and ten AI patients in 3 groups; non-functioning (NFA, n=33), possible ACS (n=65), ACS (n=12) were enrolled. Following measurements were conducted: Clinical data and total serum cortisol (TC), plasma corticotrophin (ACTH), serum dehydroepiandrosterone sulfate (DHEA-S), cortisol after 1 mg dexamethasone by both immunoassay and LC-MS/MS (DexF), serum corticosteroid binding globulin (CBG), plasma dexamethasone concentration [DEX] and plasma FC by LC-MS/MS. Patients with ACS featured an unfavorable metabolic profile. Plasma [DEX] and serum CBG levels were similar between groups. Plasma FC was significantly higher in ACS when compared to NFA and possible ACS groups p<0.05 and p<0.01, respectively. In multiple regression analysis DexF (beta=0.402, p<0.001) and CBG (beta=−0.257, p=0.03) remained as the independent predictors of plasma FC while age, sex, BMI, smoking habit, and existing cardiovascular disease did not make a significant contribution to the regression model. In conclusion, the magnitude of cortisol excess in ACS could lead to increased plasma FC concentrations. Further studies in AI patients are needed to demonstrate whether any alterations of cortisol affinity for CBG exist and to establish whether plasma FC concentrations predict the unfavorable metabolic profile in ACS.

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Salivary cortisol in a middle-aged community sample: results from 990 men and women of the KORA-F3 Augsburg study

Acta Endocrinologica ◽

10.1530/eje-10-0491 ◽

2010 ◽

Vol 163 (3) ◽

pp. 443-451 ◽

Cited By ~ 29

Author(s):

Florian Lederbogen ◽

Christine Kühner ◽

Clemens Kirschbaum ◽

Christa Meisinger ◽

Josefine Lammich ◽

...

Keyword(s):

Social Support ◽

Salivary Cortisol ◽

Perceived Social Support ◽

Community Sample ◽

Area Under The Curve ◽

Smoking Habits ◽

Cortisol Secretion ◽

Middle Aged ◽

Scientific Medicine ◽

Cross Sectional

ObjectiveAnalysis of salivary cortisol concentrations and derived indices is increasingly used in clinical and scientific medicine. However, comprehensive data on these parameters in the general population are scarce. The aim of this study was to evaluate the concentrations of salivary cortisol in a large middle-aged community sample and to identify major factors associated with altered hormone levels.DesignWe conducted a cross-sectional study within the Cooperative Health Research in the Region of Augsburg (KORA)-F3 study. A total of 1484 participants aged 50–69 years (52% women) had agreed to provide four saliva samples during a regular weekday.MethodsWe measured salivary cortisol concentrations at wake-up (F0), ½ h (F½), 8 h (F8), and 14 h (F14) after waking. We calculated cortisol awakening response (CAR), slope, and area under the curve (AUCG) of the circadian cortisol secretion. Sociodemographic and clinical characteristics were evaluated by interview and questionnaires, sampling conditions by protocol. In total, 1208 participants returned saliva samples, exclusion criteria left 990 subjects for final analyses.ResultsSalivary cortisol levels were (means±s.d.) F0=13.7±7.6, F½=20.5±9.8, F8=5.4±3.3, and F14=2.0±1.8 nmol/l. Earlier sampling times were associated with higher CAR and smaller slope. Cortisol secretion was also influenced by gender and smoking habits. Higher perceived social support was associated with lower AUCG and smaller slope.ConclusionsWe provide data on salivary cortisol concentrations in a large middle-aged community sample. Gender, sampling time, smoking habits, and perceived social support appeared as determinants of cortisol secretion.

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A Nonlinear Relationship of Generalized and Central Obesity with Diurnal Cortisol Secretion in the Whitehall II Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-2105 ◽

2010 ◽

Vol 95 (9) ◽

pp. 4415-4423 ◽

Cited By ~ 72

Author(s):

Meena Kumari ◽

Tarani Chandola ◽

Eric Brunner ◽

Mika Kivimaki

Keyword(s):

Waist Circumference ◽

Salivary Cortisol ◽

Central Obesity ◽

Complete Information ◽

Cross Sectional Study ◽

Cortisol Awakening Response ◽

Quadratic Term ◽

Cortisol Secretion ◽

Sample Collection ◽

Cross Sectional

Context: Evidence for an association of measures of generalized and central obesity with salivary cortisol secretion is equivocal. Objective: The objective of this study was to assess the relationship between body mass index (BMI), waist circumference, and salivary cortisol. Design: The design was a cross-sectional study of BMI, waist circumference, and salivary cortisol from phase 7 (2002–2004) of the Whitehall II study. Setting: The occupational cohort was originally recruited in 1985–1988. Participants: Participants included 2915 men and 1041 women aged 50–74 yr with complete information on height, weight and waist circumference, and cortisol secretion. Outcome Measures: Saliva samples were taken on waking, waking plus 0.5, 2.5, 8, and 12 h, and bedtime for the assessment of cortisol. The cortisol awakening response and slope in diurnal secretion were calculated. Results: After adjustment for age, sex, social position, waking time, and time since waking of sample collection, increasing central and generalized obesity was associated with lower waking cortisol (P = 0.001). U-shaped associations were apparent between diurnal slope in salivary cortisol and both BMI and waist circumference (P < 0.0001 for quadratic term). For example, the shallowest (most adverse) slopes in salivary cortisol were associated with highest (>31 kg/m2) and lowest (<21 kg/m2) levels of BMI, and the steepest slopes were apparent for those with BMI of 26 kg/m2, independently of the 12 covariates examined. No associations were apparent for the cortisol awakening response (P > 0.05). Conclusion: The associations of measures of generalized and central obesity with diurnal slope in salivary cortisol are not linear in older adults. These nonlinear associations may explain previously described mixed findings.

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Association of generalized and central obesity with serum and salivary cortisol secretion patterns in the elderly: findings from the cross sectional KORA-Age study

Scientific Reports ◽

10.1038/s41598-020-71204-6 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Karl-Heinz Ladwig ◽

Sonja Charlotte Schriever ◽

Seryan Atasoy ◽

Martin Bidlingmaier ◽

Johannes Kruse ◽

...

Keyword(s):

Salivary Cortisol ◽

Central Obesity ◽

The Elderly ◽

Cortisol Secretion ◽

Cross Sectional ◽

The Cross

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MON-193 Glucocorticoid Excess and Its Association with Metabolic and Cardiovascular Complications in Primary Aldosteronism

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1758 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Ke ying zhu ◽

huan chen ◽

Liu mengsi ◽

Wen-huan huan Feng ◽

da long zhu ◽

...

Keyword(s):

Cortisol Level ◽

Primary Aldosteronism ◽

Linear Regression Analysis ◽

Laboratory Data ◽

Cortisol Concentration ◽

Serum Cortisol Level ◽

Cortisol Secretion ◽

Increased Risk ◽

Free Cortisol ◽

Midnight Cortisol

Abstract Objective: To investigate autonomous cortisol secretion in patients with primary aldosteronism and its effect on metabolism and cardiovascular events (CVE) in patients with primary aldosteronism (PA). Methods: This study included 163 patients with PA and 105 sex- and age-matched patients with essential hypertension (EH). Clinical and laboratory data were collected. The expression of cortisol synthase (CYP11B1) and aldosterone synthase (CYP11B2) was investigated in adenoma tissues from 44 patients with aldosterone-producing adenoma (APA) by employing immunohistochemistry. Results: 1) CYP11B2 was expressed in 36 patients with APA and was absent in 8 patients, while CYP11B1 immunoreactivity was detected in all tested patients with APA; 2) Compared with patients with EH, midnight cortisol concentration (104.81±90.86 vs 76.87±65.86), 24-h urine free cortisol level (726.04±309.87 vs 630.65±168.2), and cortisol level after 1mg-DST [35.6(27.6,75.73)vs 27.6(27.60,29.27)]were all significantly increased in patients with PA(all P<0.01); 3) Midnight cortisol concentration is positively associated with systolic blood pressure (SBP) (r=0.147 P<0.05), LDL-C (r=0.194 P<0.05), HOMA-IR (r=0.262 P<0.05), HOMA-β (r=0.313 P<0.05) and fasting insulin level (r=0.329 P<0.05) in patients with PA. In multiple linear regression analysis, midnight cortisol concentration was a postitive predictor for SBP (β=0.185 P<0.05), HOMA-IR (β=0.331 P<0.05) and HOMA-β (β=0.390 P<0.05); 4) Of the 163 patients with PA, 35 had a history of CVE, including 22 with stroke, eight with myocardial infarction, three with atrial fibrillation, and two with heart failure. The multivariate logistic-regression analyses revealed older age (OR 1.160 95%CI 1.041-1.294 P <0.001) and higher serum aldosterone level (OR 1.013 95%CI 1.000-1.026 P <0.05) were independent risk factors of CVE, serum cortisol level was not associated with the increased risk of CVE in patients with PA (OR 0.997 95%CI 0.985-1.009 P =0.570). Conclusion: Excess cortisol secretion was common in PA. Cortisol excretion is correlated with metabolic disorders, but not associated with increased risk of CVE in patients with PA.

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Approach to the patient with adrenal incidentaloma

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab512 ◽

2021 ◽

Author(s):

Irina Bancos ◽

Alessandro Prete

Keyword(s):

Adrenal Mass ◽

Young Patients ◽

Adrenal Incidentaloma ◽

Current Evidence ◽

Adrenal Tumors ◽

Cortisol Secretion ◽

Adrenal Incidentalomas ◽

Cross Sectional ◽

Imaging Characteristics ◽

Autonomous Cortisol Secretion

Abstract Adrenal tumors are commonly discovered incidentally, on cross-sectional abdominal imaging performed for reasons other than adrenal mass. Incidence of adrenal tumors increased 10-fold in the last two decades, with most diagnosed in older adults. In any patient with a newly discovered adrenal mass determining whether the adrenal mass is malignant and whether it is hormonally active is equally important to guide the best management. Malignancy is diagnosed in 5-8% of patients with adrenal tumors, with a higher risk in young patients, if history of extra-adrenal malignancy, in those with large adrenal tumors with indeterminate imaging characteristics, and in bilateral adrenal tumors. While overt hormone excess is uncommon in adrenal incidentalomas, mild autonomous cortisol secretion can be diagnosed in up to 30-50% of patients. As autonomous cortisol secretion is associated with increased cardiovascular morbidity and metabolic abnormalities, all patients with adrenal incidentalomas require work up with dexamethasone suppression test. Management of adrenal tumors varies based on etiology, associated comorbidities, and patient’s preference. This article reviews the current evidence on the diagnosis and evaluation of patients with adrenal mass and focuses on management of the most common etiologies of adrenal incidentalomas.

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