Relationships Between 24-Hour Urinary Free Cortisol Concentrations and Metabolic Syndrome in Obese Children

As in adults, obesity also plays a central role in the development of metabolic syndrome (MS) in children. Non-alcoholic fatty liver disease (NAFLD) is considered a manifestation of MS. Not only MS but also NAFLD seem to be inversely associated with serum bilirubin concentrations, an important endogenous tissue protector when only mild elevated. The aim of the study was to evaluate the association between serum bilirubin levels and the prevalence of MS and NAFLD in Italian obese children and adolescents. A retrospective cross-sectional study was performed in 1672 patients aged from 5 to 18 years. Clinical and laboratory parameters were assessed. NAFLD was measured by liver ultrasonography. The study was approved by the Ethical Committee of the Istituto Auxologico Italiano (research project code 1C021_2020, acronym BILOB). MS was present in 24% and fatty liver (FL) in 38% of this population. Bilirubin was not associated with FL and MS as a whole, but it was inversely associated only with selected components of MS, i.e., large WC, high blood pressure and high triglycerides. Our data suggest that bilirubin is not protective against MS and NAFLD in the presence of severe obesity.

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MON-P263: Increased Awareness of Obesity is Related with Decreased Metabolic Syndrome Risk in Obese Children

Clinical Nutrition ◽

10.1016/s0261-5614(17)30826-9 ◽

2017 ◽

Vol 36 ◽

pp. S275

Author(s):

Y. Ertaş ◽

R. Bozbulut ◽

E. Köksal

Keyword(s):

Metabolic Syndrome ◽

Obese Children

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A Comparative Study of Urinary 17-Hydroxycorticosteroids, Urinary Free Cortisol, and the Integrated Concentration of Plasma Cortisol*

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem-51-5-1099 ◽

1980 ◽

Vol 51 (5) ◽

pp. 1099-1101 ◽

Cited By ~ 19

Author(s):

ZVI ZADIK ◽

LUIZ DE LACERDA ◽

LUIZ A. H. DE CARMARGO ◽

BRUCE P. HAMILTON ◽

CLAUDE J. MIGEON ◽

...

Keyword(s):

Comparative Study ◽

Plasma Cortisol ◽

Urinary Free Cortisol ◽

Free Cortisol

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Applications of a modified Cortipac procedure for the estimation of urinary free cortisol in various clinical situations.

Journal of Clinical Pathology ◽

10.1136/jcp.33.1.89 ◽

1980 ◽

Vol 33 (1) ◽

pp. 89-92 ◽

Cited By ~ 2

Author(s):

P West

Keyword(s):

Urinary Free Cortisol ◽

Free Cortisol

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THE EFFECTS OF DEXAMETHASONE AND ANDROGENS ON SEXUAL RECEPTIVITY OF FEMALE RHESUS MONKEYS

Journal of Endocrinology ◽

10.1677/joe.0.0510575 ◽

1971 ◽

Vol 51 (3) ◽

pp. 575-588 ◽

Cited By ~ 50

Author(s):

B. J. EVERITT ◽

J. HERBERT

Keyword(s):

Rhesus Monkeys ◽

Testosterone Propionate ◽

Secretory Activity ◽

Urinary Free Cortisol ◽

Sexual Receptivity ◽

Adrenal Androgens ◽

Electrolyte Metabolism ◽

Free Cortisol ◽

Female Rhesus ◽

The Central Nervous System

SUMMARY The effect of dexamethasone, given either alone or together with testosterone propionate or androstenedione, was studied in nine female rhesus monkeys (paired with three males) by making quantitative observations on behaviour in the laboratory. Dexamethasone (0·5 mg/kg/day) given to oestrogen-treated ovariectomized female monkeys made them sexually unreceptive, and there was an associated decline in the level of the male's mounting activity. Testosterone propionate (100 or 200 μg/day) reversed completely the effects of dexamethasone on sexual behaviour. Androstenedione (100, 200 or 400 μg/day) had similar, but less marked, effects whereas cortisol (10 mg/day) or progesterone (100, 200 or 500 μg/day) were ineffective. Treating a female with testosterone prevented dexamethasone from reducing sexual receptivity. Parallel determinations of urinary free cortisol showed that the dexamethasone had suppressed the secretory activity of the adrenal cortex. There were no consistent changes, under any treatment, in the females' vaginal epithelia, sexual skins or clitorides, or in their water or electrolyte metabolism. These findings indicate that adrenal androgens regulate sexual receptivity in these female primates, probably by an action on the central nervous system.

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Paediatric reference range for overnight urinary cortisol corrected for creatinine

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2021-0371 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Ole D. Wolthers ◽

Mark Lomax ◽

Anne Vibeke Schmedes

Keyword(s):

Mass Spectrometry ◽

Reference Range ◽

Inhaled Corticosteroids ◽

Prediction Interval ◽

Geometric Mean ◽

Urinary Free Cortisol ◽

Urinary Cortisol ◽

Cross Sectional ◽

Systemic Activity ◽

Free Cortisol

Abstract Objectives Systemic activity of inhaled corticosteroids (ICS) may be assessed via urinary cortisol measurement. Overnight urinary free cortisol corrected for creatinine (OUFCC) has been extensively reported in adult studies. However, a paediatric mass spectrometric (MS) reference range for OUFCC is not established. MS methods for OUFCC avoid cross-reactivity with other steroid hormones and are thus preferable to immunoassays. The aim of the present study was to define an MS OUFCC normative range in children. Methods This was a cross-sectional study of healthy pre-pubertal children from 5 to 11 years. Children collected urine from 10 pm or bedtime, whichever was earlier, until 8 am. Urinary free cortisol was measured via a liquid chromatography tandem mass spectrometry (LC-MS/MS) assay (Acquity UPLC with Xevo TQ-S Mass Spectrometer [Waters]) with in-house reagents. Urinary creatinine was measured using a commercial assay (Roche). Results Complete urine collections were obtained from 72 males and 70 females, mean age (SD) 8.6 (1.9) (range 5.0–11.8) years. The OUFCC 95% prediction interval was 1.7–19.8 nmol/mmol. Geometric mean OUFCC was 5.7; range 1.1–24.8 nmol/mmol. Conclusions The obtained normative LC-MS/MS OUFCC reference data facilitate the use of mass spectrometry OUFCC assays in assessment of systemic activity of endogenous and exogenous corticosteroids in children.

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Abstract P088: Obesity, Hypertension and Insulin Resistance in a Primary Pediatric Setting in Southern Italy

Circulation ◽

10.1161/circ.129.suppl_1.p088 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Giampaolo De Filippo ◽

Domenico Rendina ◽

Domenico Viggiano ◽

Antonio Fasolino ◽

Paola Sabatini ◽

...

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Body Weight ◽

Children And Adolescents ◽

Diagnostic Criteria ◽

Southern Italy ◽

Serum Insulin ◽

High Density Lipoproteins ◽

Obese Children ◽

Campania Region

Background: Obesity is the main risk factor for essential hypertension (EH) in childhood. The O.Si.Me. study (Obesity and Metabolic Syndrome in children and adolescents) evaluated the prevalence of metabolic syndrome (MetS) and its constitutive traits in a sample of obese children and adolescents living in Campania, southern Italy. Patients and methods: Four hundred and fifteen children and adolescents consecutively referred to the National Health Service participating Outpatient Clinics for minor health problems and found to have a Body Mass Index (BMI) Z-score > 2.0 were enrolled in the study. The entire sample was screened for MetS, which was defined as the presence of at least 2 of the following alterations in addition to obesity: fasting hyperglycemia, low levels of high-density lipoproteins cholesterol, hypertriglyceridemia, and EH. The present analysis evaluated the clinical characteristics of the O.Si.Me subgroup of EH participants (systolic and/or diastolic BP ≥ 95 th percentile for age, gender and height) as compared with normotensive participants. Results: The prevalence of EH in the O.Si.Me population was 23.6 % (98/415, 48M and 50F.) and two-thirds of the EH participants met the MetS diagnostic criteria. The EH participants featured serum insulin and HOMA-IR levels significantly higher compared with normotensive ones (11.6±0.6 vs. 9.5±0.4 μIU/ml, p = 0.014; 2.6±0.1 vs. 2.2±0.1, p = 0.028 for insulin and HOMA-IR, respectively). These differences were common to boys and girls and remained significant after correction for age, pubertal stage, body weight, length, BMI, gestational age at birth, duration of breastfeeding and anthropometric parental parameters. Accordingly, children and adolescents with EH had a a relative risk of being insulin resistant (defined as a HOMA-IR ≥2.5) significantly greater compared to those without. Moreover, they exhibited higher serum creatinine levels (53.8±7.1 vs. 35.4±6.8 μmol/l, p=0.025) accounting for gender and body weight. Conclusions: More than a quarter of obese children and adolescents meet the diagnostic criteria for EH in the Campania region in southern Italy. These obese boys and girls have an increased prevalence of insulin resistance and apparently an initial reduction in renal function compared with obese children and adolescents with normal BP.

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Metabolic Syndrome in Italian Obese Children and Adolescents: Stronger Association with Central Fat Depot than with Insulin Sensitivity and Birth Weight

International Journal of Hypertension ◽

10.4061/2011/257168 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Claudia Brufani ◽

Danilo Fintini ◽

Ugo Giordano ◽

Alberto Enrico Tozzi ◽

Fabrizio Barbetti ◽

...

Keyword(s):

Metabolic Syndrome ◽

Birth Weight ◽

Insulin Sensitivity ◽

Low Birth Weight ◽

Children And Adolescents ◽

Central Obesity ◽

Obese Children ◽

Obesity Index ◽

Central Fat ◽

Fat Depot

Aim. To evaluate whether body fat distribution, birth weight, and family history for diabetes (FHD) were associated with metabolic syndrome (MetS) in children and adolescents.Methods. A total of 439 Italian obese children and adolescents (5–18 years) were enrolled. Subjects were divided into 2 groups: prepubertal and pubertal. MetS was diagnosed according to the adapted National Cholesterol Education Program criteria. Birth weight percentile, central obesity index (measured by dual-energy X-ray absorptiometry), insulin sensitivity (ISI), and disposition index were evaluated. Multivariate logistic regression models were used to determine variables associated with MetS.Results. The prevalence of MetS was 17%, with higher percentage in adolescents than in children (21 versus 12%). In the overall population, central obesity index was a stronger predictor of MetS than insulin sensitivity and low birth weight. When the two groups were considered, central fat depot remained the strongest predictor of MetS, with ISI similarly influencing the probability of MetS in the two groups and birth weight being negatively associated to MetS only in pubertal individuals. Neither FHD nor degree of fatness was a significant predictor of MetS.Conclusion. Simple clinical parameters like increased abdominal adiposity and low birth weight could be useful tools to identify European obese adolescents at risk for metabolic complications.

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Spontaneous remission of hypercortisolism presumed due to asymptomatic tumor apoplexy in ACTH-producing pituitary macroadenoma

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302013000600012 ◽

2013 ◽

Vol 57 (6) ◽

pp. 486-489 ◽

Cited By ~ 4

Author(s):

Marcio Carlos Machado ◽

Patricia Sampaio Gadelha ◽

Marcello Delano Bronstein ◽

Maria Candida Barisson Vilares Fragoso

Keyword(s):

Salivary Cortisol ◽

Signs And Symptoms ◽

Spontaneous Remission ◽

Pituitary Surgery ◽

Serum Cortisol ◽

Urinary Free Cortisol ◽

High Plasma ◽

Imaging Data ◽

Cystic Component ◽

Free Cortisol

Cushing's disease (CD) is usually caused by secretion of ACTH by a pituitary corticotroph microadenoma. Nevertheless, 7%-20% of patients present with ACTH-secreting macroadenomas. Our aim is to report a 36-year-old female patient with CD due to solid-cystic ACTH-macroadenoma followed up during 34 months. The patient presented spontaneous remission due to presumed asymptomatic tumor apoplexy. She showed typical signs and symptoms of Cushing's syndrome (CS). Initial tests were consistent with ACTH-dependent CS: elevated urinary free cortisol, abnormal serum cortisol after low dose dexamethasone suppression test, and elevated midnight salivary cortisol, associated with high plasma ACTH levels. Pituitary magnetic resonance imaging (MRI) showed a sellar mass of 1.2 x 0.8 x 0.8 cm of diameter with supra-sellar extension leading to slight chiasmatic impingement, and showing hyperintensity on T2-weighted imaging, suggesting a cystic component. She had no visual impairment. After two months, while waiting for pituitary surgery, she presented spontaneous resolution of CS. Tests were consistent with remission of hypercortisolism: normal 24-h total urinary cortisol and normal midnight salivary cortisol. Pituitary MRI showed shrinkage of the tumor with disappearance of the chiasmatic compression. She has been free from the disease for 28 months (without hypercortisolism or hypopituitarism). The hormonal and imaging data suggested that silent apoplexy of pituitary tumor led to spontaneous remission of CS. However, recurrence of CS was described in cases following pituitary apoplexy. Therefore, careful long-term follow-up is required.

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