scholarly journals Salivary cortisol measurement in normal-weight, obese and anorexic women: comparison with plasma cortisol

2001 ◽  
pp. 165-171 ◽  
Author(s):  
P Putignano ◽  
A Dubini ◽  
P Toja ◽  
C Invitti ◽  
S Bonfanti ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Plasma Cortisol ◽  
Visceral Obesity ◽  
Normal Weight ◽  
Obese Patients ◽  
Healthy Women ◽  
Free Cortisol ◽  
Drug Free

OBJECTIVE: To compare salivary, plasma and urinary free cortisol (UFC) measurements in patients with anorexia nervosa, in whom an overdrive of the hypothalamic-pituitary-adrenal (HPA) axis is well established but information on salivary cortisol is lacking, in viscerally obese patients in whom subtle abnormalities of cortisol secretion and metabolism are postulated, and in normal-weight healthy women. PARTICIPANTS AND EXPERIMENTAL DESIGN: Measurement of salivary cortisol offers a convenient way to assess the concentrations of free, biologically active cortisol in plasma in different physiopathological settings. Forty-seven drug-free, newly diagnosed women with active restrictive anorexia nervosa, 30 restrictive anorexic women undergoing chronic psychopharmacological treatment, 47 women with mild-to-moderate visceral obesity, 103 women with severe central obesity and 63 normal-weight healthy women entered the study. Salivary and blood samples were collected at 0800 h, 1700 h and 2400 h, together with three consecutive 24-h urine specimens for UFC determination. In controls and patients with anorexia nervosa (n=83), salivary and plasma cortisol were also measured after a 1-mg overnight dexamethasone suppression test (DST). In patients with anorexia nervosa, mood was rated by the Hamilton scale for anxiety and depression. RESULTS: Untreated patients with anorexia nervosa showed increased plasma and salivary cortisol and UFC concentrations (all P<0.001 compared with controls), and decreased cortisol suppression after DST in plasma and saliva (P<0.0001 and P<0.005 respectively compared with controls). These alterations were less pronounced, although still statistically significant, in treated patients with anorexia nervosa. Salivary cortisol was highly correlated with paired plasma cortisol in the whole population and after splitting the participants by group (P<0.0001). However, for plasma cortisol values greater than 500 nmol/l (the corticosteroid-binding globulin saturation point), this parallelism was lost. Taking plasma cortisol as a reference, the level of agreement for post-dexamethasone salivary and plasma cortisol was 58.9% among suppressors and 77.8% among non-suppressors (chi2 test: P<0.01). Decreased 0800 h/2400 h cortisol ratios were observed in plasma and saliva in drug-free patients with anorexia nervosa (P<0.005 and P<0.05 respectively compared with controls), and in saliva in severely obese patients (P<0.05 compared with controls). Depression and anxiety scores were unrelated to cortisol concentrations in any compartment. CONCLUSIONS: Salivary cortisol measurement is a valuable and convenient alternative to plasma cortisol measurement. It enables demonstration of the overdrive of the HPA axis in anorexia nervosa and subtle perturbations of the cortisol diurnal rhythm in women with visceral obesity. With the establishment of more specific and widely acceptable cut-off values for dynamic testing, measurement of salivary cortisol could largely replace plasma cortisol measurement.

Effect of sleep apnea syndrome on the circadian profile of cortisol in obese men

2007 ◽  
Vol 293 (2) ◽  
pp. E466-E474 ◽  
Author(s):  
F. Dadoun ◽  
P. Darmon ◽  
V. Achard ◽  
S. Boullu-Ciocca ◽  
F. Philip-Joet ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Salivary Cortisol ◽  
Repeated Measures ◽  
Plasma Cortisol ◽  
Sleep Apnea Syndrome ◽  
Visceral Obesity ◽  
Normal Weight ◽  
Apnea Hypopnea Index ◽  
Apnea Syndrome ◽  
Cortisol Levels

It has been hypothesized that sleep apnea syndrome (SAS) increases hypothalamic-pituitary-adrenal axis activity and, through increased cortisol levels, participates in the pathophysiology of metabolic and cardiovascular complications. We compared the circadian profiles of cortisol in obese men with [obSAS+; apnea-hypopnea index (AHI) ≥ 20/h] and without SAS (obSAS−; AHI ≤ 5/h). 1) Salivary cortisol (5 samples: before/30 min after dinner, 2100, upon/30 min after awakening) was measured in 15 obSAS+, 19 obSAS−, and 19 normal-weight controls (NWC). 2) Plasma cortisol (every 30 min for 24 h under highly controlled conditions and portable EEG device) was measured in 9 obSAS+, 8 obSAS−, and 10 NWC men. Visceral adipose tissue surface was measured by CT scan. In both studies, obSAS+ and obSAS− men were comparable for age, BMI, waist circumference, and waist-to-hip ratio. First, no difference was found, using ANOVA for repeated measures, between obSAS+ and obSAS− subjects for any salivary cortisol measurement. No correlation was found between salivary cortisol and AHI or nocturnal SaO2. Similarly, obSAS+ and obSAS− men showed no difference in plasma cortisol rhythmicity: 24-h minimum, maximum, and mean, ANOVA for repeated measures, mathematical modeling of cortisol rhythm (COSINOR), and morning secretory peak. Conversely, ANOVA for repeated measures showed decreased cortisol levels in obese vs. NWC men during both the trough (2200–0130) and the peak (0600–0900) independently of SAS status. We show that SAS per se is not associated with any change of the level or of the features of salivary and plasma cortisol rhythmicity and confirm that men with visceral obesity display lower plasma cortisol levels than NWC men.

scholarly journals Cortisol in tissue and systemic level as a contributing factor to the development of metabolic syndrome in severely obese patients

2015 ◽  
Vol 172 (1) ◽  
pp. 69-78 ◽  
Author(s):  
Petros Constantinopoulos ◽  
Marina Michalaki ◽  
Anastasia Kottorou ◽  
Ioannis Habeos ◽  
Agathoklis Psyrogiannis ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Adipose Tissue ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Glucocorticoid Receptors ◽  
Area Under The Curve ◽  
Mrna Levels ◽  
Obese Patients ◽  
Free Cortisol ◽  
Severely Obese

ContextAdrenal and extra-adrenal cortisol production may be involved in the development of metabolic syndrome (MetS).ObjectiveTo investigate the activity of the hypothalamic–pituitary–adrenal (HPA) axis and the expression of HSD11B1, nuclear receptor subfamily 3, group C, member 1 (glucocorticoid receptors) α (NR3C1α) and β (NR3C1β) in the liver, subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) of severely obese patients with and without MetS.MethodsThe study included 37 severely obese patients (BMI ≥40 kg/m2), 19 with MetS (MetS+ group) and 18 without (MetS− group), studied before and during bariatric surgery. Before the day of surgery, urinary free cortisol (UFC) and diurnal variation of serum and salivary cortisol were estimated. During surgery, biopsies of the liver, VAT and SAT were obtained. The expression of HSD11B1, NR3C1α and NR3C1β was evaluated by RT-PCR.ResultsUFC and area under the curve for 24-h profiles of serum and salivary cortisol were lower in the MetS− group. In the MetS− group, mRNA levels of HSD11B1 in liver exhibited a negative correlation with liver NR3C1α (LNR3C1α) and VAT expression of HSD11B1 was lower than the MetS+ group.ConclusionsWe observed a downregulation of the NR3C1α expression and lower VAT mRNA levels of HSD11B1 in the MetS− group, indicating a lower selective tissue cortisol production and action that could protect these patients from the metabolic consequences of obesity. In the MetS− group, a lower activity of the HPA axis was also detected. Taken together, cortisol in tissue and systematic level might play a role in the development of MetS in severely obese patients.

Investigation of Salivary Cortisol Response to Awakening in Underweight and Weight-Restored Patients with Anorexia Nervosa

2017 ◽  
Vol 41 (S1) ◽  
pp. S283-S283
Author(s):  
F. Pellegrino ◽  
A.M. Monteleone ◽  
M. Nigro ◽  
V. Ruzzi ◽  
M. Cimino ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Hpa Axis ◽  
Normal Weight ◽  
Cortisol Awakening Response ◽  
Healthy Controls ◽  
State Trait Anxiety Inventory ◽  
State Dependent ◽  
Competing Interest ◽  
First Time ◽  
Primary Phenomenon

IntroductionAnorexia nervosa (AN) is characterized by dysregulated eating that leads to chronic malnutrition, which may be responsible for several physical complications, including endocrine alterations, such as hyperactivity of the hypothalamus-pituitary-adrenal (HPA) axis.ObjectivesSeveral studies have shown a dysregulation of the cortisol awakening response (CAR) in symptomatic AN patients. However, it has not been established if the deranged CAR of underweight AN patients is a primary phenomenon or an alteration secondary to malnutrition.AimsThe aim of this study was to explore the salivary CAR in both underweight and weight-restored patients with AN.MethodsWe recruited 59 women: 18 undernourished AN patients, 15 weight-restored AN women and 26 normal-weight healthy controls. Saliva samples were collected in the morning, immediately after awakening and after 15, 30 and 60 minutes, in order to measure saliva levels of cortisol. Participants filled in the state-trait anxiety inventory (STAI) to test their anxiety levels in the morning of the test.ResultsCompared to healthy controls, underweight AN patients showed an enhanced CAR whereas the weight recovered patients had a normal CAR. These results were not correlated with levels of anxiety.ConclusionsFor the first time, our results demonstrate that the deranged CAR found in acute AN patients is not present in weight-restored ones, suggesting that altered activity of the HPA axis of symptomatic AN patients is a state-dependent phenomenon.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Plasma Melatonin Levels in Anorexia Nervosa

1992 ◽  
Vol 161 (3) ◽  
pp. 361-364 ◽  
Author(s):  
Josephine Arendt ◽  
S. Bhanji ◽  
Christine Franey ◽  
D. Mattingly
Keyword(s):  
Anorexia Nervosa ◽  
Circadian Rhythm ◽  
Normal Weight ◽  
Nocturnal Hypoglycaemia ◽  
Plasma Melatonin ◽  
Healthy Women

Plasma melatonin levels were measured at three-hourly intervals over 24 hours in 11 women with untreated anorexia nervosa, and in nine healthy women of normal weight. The circadian rhythm was unaltered but the nocturnal secretion of melatonin was significantly greater in anorectics. It is possible that this was related to nocturnal hypoglycaemia.

Asymmetry of salivary cortisol and α-amylase responses to psychosocial stress in anorexia nervosa but not in bulimia nervosa

2011 ◽  
Vol 41 (9) ◽  
pp. 1963-1969 ◽  
Author(s):  
P. Monteleone ◽  
P. Scognamiglio ◽  
B. Canestrelli ◽  
I. Serino ◽  
A. M. Monteleone ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Stress Response ◽  
Bulimia Nervosa ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Social Stress ◽  
Stress Test ◽  
Trier Social Stress Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
First Time

BackgroundThe stress response involves the activation of the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system (SNS). As a role for stress in determining of the onset and the natural course of eating disorders (EDs) has been proposed, the study of the psychobiology of the stress response in patients with anorexia nervosa (AN) and bulimia nervosa (BN) should be helpful in understanding the pathophysiology of these disorders. The two neurobiological components of the stress response can be easily explored in humans by the measurement of salivary cortisol and α-amylase response to a stressor. Therefore, we assessed salivary cortisol and α-amylase responses to the Trier Social Stress Test (TSST) in symptomatic patients with AN and BN compared to healthy controls.MethodSeven AN women, eight BN women and eight age-matched healthy females underwent the TSST between 1530 and 1700 h. Salivary cortisol and α-amylase levels were measured by an enzyme-linked immunosorbent assay (ELISA).ResultsCompared to healthy women, AN patients showed a normal cortisol response to the TSST, although this occurred at significantly increased hormone levels, and an almost complete absence of response of α-amylase. BN women, however, exhibited enhanced pre-stress levels of salivary α-amylase but a normal response of the enzyme and cortisol to the TSST.ConclusionsThese findings demonstrate, for the first time, the occurrence of an asymmetry between the HPA axis and SNS components of the stress response in the acute phase of AN but not in BN. The pathophysiological significance of this asymmetry remains to be determined.

Dexamethasone fails to suppress hyperendorphinaemia of obese children

1987 ◽  
Vol 116 (1) ◽  
pp. 90-94 ◽  
Author(s):  
F. Facchinetti ◽  
C. Livieri ◽  
F. Petraglia ◽  
L. Cortona ◽  
F. Severi ◽  
...  
Keyword(s):  
Plasma Cortisol ◽  
Normal Weight ◽  
Acid Extraction ◽  
Obese Patients ◽  
Obese Children ◽  
Dexamethasone Treatment ◽  
Normal Range ◽  
Short Term ◽  
Hormone Levels ◽  
Weight Excess

Abstract. In order to evaluate the origin of hyperendorphinaemia in obese patients, plasma B-endorphin (B-EP), B-lipotropin (B-LPH) and cortisol levels were measured in basal conditions and after overnight treatment with 1 mg of dexamethasone. Thirteen obese children (weight excess ranging from 44 to 100%) and 10 normal weight controls were studied. Weight gain started in prepuberty and could not be explained by concurrent diseases. Hormone levels were measured by RIA, either directly in the plasma (cortisol) or after silicic acid extraction and Sephadex G-75 column chromatography (B-EP and B-LPH). Basal B-EP levels in the obese children (19.4 ± 4.9 pmol/l, mean ± sem) were significantly higher than in the controls (7.8 ± 1.2, P < 0.01), whereas B-LPH and cortisol was within normal range. In the controls, post-dexamethasone morning and afternoon hormone levels were significantly suppressed. In the obese children, B-EP concentrations remained unaffected by the treatment (14.6 ± 5.3 and 14.9 ± 5.2 at 08.00 and 16.00 h, respectively), whereas both B-LPH and cortisol values were significantly decreased. These data demonstrate that a short-term dexamethasone treatment is unable to correct the increased B-EP levels which characterize obese children, whereas it is effective on B-LPH and cortisol concentrations. It can be concluded that circulating B-EP in this condition loses the control of CRH. However, the origin of hyperendorphinaemia in obese patients still remains to be investigated.

Cortisol awakening response in patients with anorexia nervosa or bulimia nervosa: relationships to sensitivity to reward and sensitivity to punishment

2014 ◽  
Vol 44 (12) ◽  
pp. 2653-2660 ◽  
Author(s):  
P. Monteleone ◽  
P. Scognamiglio ◽  
A. M. Monteleone ◽  
D. Perillo ◽  
M. Maj
Keyword(s):  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Hpa Axis ◽  
Personality Characteristics ◽  
Cortisol Awakening Response ◽  
Behavioural Inhibition ◽  
Sensitivity To Reward ◽  
Healthy Women ◽  
Hpa Axis Activity ◽  
Sensitivity To Punishment

BackgroundSensitivity to punishment (SP) and sensitivity to reward (SR) are personality characteristics that may have relevance for the pathophysiology of eating disorders (EDs). Moreover, personality characteristics are known to modulate the activity of the hypothalamus–pituitary–adrenal (HPA) axis, which is the main component of the endogenous stress response system. As stress has been implicated in the aetiology and the maintenance of EDs, we aimed to study the HPA axis activity in relation to SP and SR, as conceptualized by Gray's reinforcement sensitivity theory (RST), in patients with anorexia nervosa (AN) or bulimia nervosa (BN).MethodTwenty-five women with AN, 23 women with BN and 19 healthy women volunteered for the study. HPA axis activity was assessed by measurement of the salivary cortisol awakening response (CAR). The subjects’ SP and SR were measured by the behavioural inhibition system (BIS)/behavioural approach system (BAS) scales.ResultsThe CAR was significantly enhanced in AN patients, but not in BN patients, compared to healthy women. The CAR correlated significantly with BAS measures, negatively in healthy controls and positively in binge-purging AN patients and BN women. SP, measured by the BIS scale, was higher in patients than in controls.ConclusionsThese findings confirm the occurrence of an enhanced activity of the HPA axis in symptomatic AN, but not in symptomatic BN, and show for the first time that the CAR is associated with SR, as conceptualized by the RST, negatively in healthy subjects but positively in binge-purging ED patients.

Cortisol awakening response in binge-purging and restrictive anorexia nervosa

2017 ◽  
Vol 41 (S1) ◽  
pp. S558-S558
Author(s):  
M. Nigro ◽  
A.M. Monteleone ◽  
F. Pellegrino ◽  
M. Cimino ◽  
V. Di Maso ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Hpa Axis ◽  
Cortisol Awakening Response ◽  
Eating Disorder Inventory ◽  
Severe Restriction ◽  
Healthy Women ◽  
Stress Response System ◽  
Competing Interest ◽  
Hpa Axis Functioning ◽  
First Time

IntroductionAnorexia nervosa (AN) is a complex psychiatric disorder characterized by severe restriction of food intake and aberrant behaviours. The endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, may have a role in the pathophysiology of AN.ObjectivesIt has been shown that specific clinical traits of AN, such as binge-purging behaviours, may be associated with higher psychopathology and poorer outcomes. Therefore, the HPA axis functioning could differ between patients with restrictive AN (ANR) and those with binge-purging AN (ANBP).AimsIn order to evaluate whether HPA axis functioning differs between the two subtypes of AN, we assessed the cortisol awakening response (CAR) of symptomatic ANR and ANBP patients.MethodsOur sample included 17 ANBP and 18 ANR patients, and 42 healthy women. All of them filled in the Eating Disorder Inventory-2 (EDI-2). For CAR assessment, participants collected saliva samples at home. Saliva cortisol concentrations were measured by an enzyme immunoassay method.ResultsANR and ANBP patients exhibited a CAR significantly higher than healthy women. Furthermore, the CAR of ANBP women was higher than that of ANR women and positively correlated with the bulimia subitem score of the EDI-2.ConclusionsPresent findings show, for the first time, differences in the CAR between ANBP and ANR subtypes supporting the idea that binge-purging behaviours may have a specific connection with HPA axis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals SUN-221 Subclinical Alpha-1 Antitrypsin Deficiency Is Associated with Increased Free Cortisol Fraction in Plasma and Altered Glucocorticoid Delivery to Tissues

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Luke David Boyle ◽  
Mark Nixon ◽  
Caroline M Underhill ◽  
Lesley A Hill ◽  
Natalie Z M Homer ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Negative Feedback ◽  
Neutrophil Elastase ◽  
Plasma Cortisol ◽  
Binding Capacity ◽  
Isotopic Dilution ◽  
Crash Testing ◽  
Free Cortisol ◽  
A1at Deficiency ◽  
Alpha 1 Antitrypsin

Abstract Background Corticosteroid Binding Globulin (CBG) binds &gt;85% of plasma cortisol and controls the circulating free cortisol pool. Proteolytic cleavage by neutrophil elastase is proposed to reduce CBG binding affinity and increase free cortisol availability to inflamed tissues. The CORtisol NETwork (CORNET) consortium found that genetic variation at a locus spanning SERPINA1 (encoding alpha-1 antitrypsin, A1AT, the endogenous inhibitor of neutrophil elastase) and SERPINA6 (CBG) contributes to morning total plasma cortisol variation. We hypothesised that A1AT deficiency increases CBG cleavage and hence free plasma cortisol, resulting in increased tissue cortisol delivery in adipose and in HPA axis negative feedback. We tested this in recall-by-genotype studies of people who are heterozygous for inactivating mutations in SERPINA1. Methods 16 healthy carriers of one of the two most common A1AT-deficiency single nucleotide polymorphisms (rs17580 & rs28929474) and 16 age-, gender- and BMI-matched controls were recruited from the Generation Scotland Biobank. Participants underwent combined receptor antagonist stimulation of the HPA axis (‘CRASH’) testing using RU486 400mg and spironolactone 200mg, or placebo in a double blind randomised crossover design. Plasma free cortisol was measured by isotopic dilution and ultrafiltration, total cortisol by LC-MS/MS, total CBG by ELISA, CBG binding capacity by radioligand displacement assay, and ACTH by immunoassay. Serum A1AT was measured by ELISA. Tissue cortisol (LC-MS/MS) and expression of glucocorticoid dependent transcripts (qPCR) were measured in subcutaneous adipose samples collected by needle biopsy. Results Serum A1AT was confirmed lower in those with heterozygous mutations vs wild type controls (411.3 +/- 27.44 vs 565.1 +/- 23.38 mg/dL, p=0.0002). No measurable differences in total CBG or CBG binding capacity were observed. However, plasma free cortisol fraction was higher in those carrying A1AT mutations (16.13 +/- 0.2 vs 13.88 +/- 0.04 %, p&lt;0.0001). Adipose cortisol concentrations were not significantly different but expression of glucocorticoid responsive genes e.g. PER1 was 54% higher (p=0.014) in A1AT-deficient subjects. Plasma cortisol was elevated during CRASH testing in both groups, with the increment versus placebo tending to be lower in A1AT-deficient subjects (82.5 +/- 6.7 vs 126.7 +/- 6.8 nM). Conclusion Alpha-1 antitrypsin mutation heterozygosity, common in the general population, is associated with higher free cortisol fraction, consistent with enhanced cleavage of CBG. This is associated with evidence of enhanced delivery of glucocorticoid to adipose tissues but reduced HPA negative feedback, suggesting tissue-specific control of cortisol delivery by CBG.

EARLY VARIATIONS OF PLASMA CORTISOL AFTER PULSE INTRAVENOUS INJECTION OF DIBUTYRYL CYCLIC ADENOSINE 3′,5′-MONOPHOSPHATE IN NORMAL SUBJECTS

1973 ◽  
Vol 72 (4) ◽  
pp. 753-761 ◽  
Author(s):  
Alberto Angeli ◽  
Giuseppe Boccuzzi ◽  
Roberto Frajria ◽  
Daniela Bisbocci ◽  
Franco Ceresa
Keyword(s):  
Intravenous Injection ◽  
Plasma Cortisol ◽  
Time Course ◽  
Healthy Adult ◽  
Normal Subjects ◽  
Adult Women ◽  
Healthy Women ◽  
Adrenal Steroidogenesis ◽  
The Mean ◽  
Zero Time

ABSTRACT 10 mg/kg of dibutyryl cyclic adenosine 3′,5′-monophosphate (Db-cAMP) was iv pulse injected into twelve healthy adult women. The plasma cortisol levels were determined as 11-OHCS at zero time and then at 2.5, 5, 7.5, 10, 15, 30, 60 and 180 min after the injection. The data were compared with those obtained at the corresponding times in two groups of eleven and seventeen healthy women after the injection of 250 ng and 250 μg of synthetic β-1-24 corticotrophin performed in the same manner as the injection of the nucleotide. The mean increments in plasma cortisol were significantly lower after Db-cAMP than after ACTH. Differences were noted by analyzing the time course of the responses. In the case of stimulation with Db-cAMP the 11-OHCS levels rose progressively to a maximum at 15–30 min. By contrast, a peak of plasma cortisol was evident in most cases within a few min after the injection of ACTH; after a fall, a later rise was then observed starting from 15 min. The differences in the plasma 11-OHCS responses after the two stimuli may also be of interest clinically for the investigation of some aspects of adrenal steroidogenesis.

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