The Association of Cortisol Excretion with Weight and Metabolic Parameters in Nondiabetic Patients with Morbid Obesity

<b><i>Introduction:</i></b> Cortisol is involved in the regulation of gluconeogenesis and glucose utilization. In morbid obesity (MO), the association of cortisol excretion with metabolic parameters is not well-characterized. In our study, we evaluated cortisol excretion in nondiabetic subjects with MO and its effect on glucose metabolism. <b><i>Methods:</i></b> We included 1,249 nondiabetic patients with MO (79.8% females, mean BMI 44.9 ± 6.5 kg/m², mean age 38 ± 11 years). Anthropometric data and cardiovascular risk factors were assessed, and an oral glucose tolerance test for calculation of insulin resistance was performed. Cortisol excretion was assessed on 2 consecutive days (24 h urine specimens). <b><i>Results:</i></b> Regarding cortisol excretion, patients were divided into 3 tertiles (urinary cortisol ≤51.6, &#x3e;51.6 and &#x3c;117.6, and ≥117.6 μg/24 h, respectively). Patients in the highest tertile were younger (<i>p</i> = 0.003), more obese (BMI: <i>p</i> = 0.040), had lower diastolic blood pressure ([DBP]; <i>p</i> = 0.012), lower total (<i>p</i> = 0.032) and LDL cholesterol (<i>p</i> = 0.021), fasting (<i>p</i> = 0.049) and 2-h glycemia (<i>p</i> = 0.028), 2-h insulinemia (<i>p</i> = 0.020), and HbA1c (<i>p</i> &#x3c; 0.001), and a higher estimated glomerular filtration rate (eGFR) (<i>p</i> &#x3c; 0.001). The glucose (<i>p</i> &#x3c; 0.001) and insulin (<i>p</i> = 0.011) area under the curve (AUC) were also lower. Urinary cortisol excretion adjusted for age, sex, and eGFR was positively correlated with body weight (BW, beta = 0.076, <i>p</i> = 0.004) and overall glucose tolerance (oral disposition index, beta = 0.090, <i>p</i> = 0.011), and negatively with HbA1c (beta = −0.179, <i>p</i> &#x3c; 0.001), 2-h glycemia (beta = −0.075, <i>p</i> = 0.032), AUC glucose (beta = −0.103, <i>p</i> = 0.002), and DBP (beta = −0.139, <i>p</i> &#x3c; 0.001). HbA1c, BW, and DBP remained significant after multivariable analysis. <b><i>Discussion/Conclusion:</i></b> Despite being more obese, patients with higher cortisol excretion have a more favorable metabolic profile. These results deserve further attention regarding the respective mechanisms.

Sex-specific differences in HPA axis activity in VLBW preterm newborns

Objective Sex-specific differences in hypothalamic-pituitary-adrenal axis activity might explain why male preterm infants are at higher risk of neonatal mortality and morbidity than their female counterparts. We examined whether male and female preterm infants differed in cortisol production and metabolism at 10 days post-partum. Design and methods This prospective study included 36 preterm born infants (18 boys) with a very low birth weight (VLBW) (<1.500 gram). At 10 days postnatal age, urine was collected over a 4- to 6-hr period. Glucocorticoid metabolites were measured using gas chromatography-mass spectrometry. Main outcome measures were: (1) cortisol excretion rate, (2) sum of all glucocorticoid metabolites, as an index of corticosteroid excretion rate, and (3) ratio of 11-OH/11-OXO metabolites, as an estimate of 11β-hydroxysteroid dehydrogenase (11β-HSD) activity. Differences between sexes, including interaction with Score of Neonatal Acute Physiology Perinatal Extension-II (SNAPPE II), sepsis and bronchopulmonary dysplasia (BPD), were assessed. Results No differences between sexes were found for cortisol excretion rate, corticosteroid excretion rate or 11β-HSD activity. Interaction was observed between: sex and SNAPPE II score on 11β-HSD activity (p=0.04) and sex and BPD on cortisol excretion rate (p=0.04). Conclusion This study did not provide evidence for sex-specific differences in adrenocortical function in preterm VLBW infants on a group level. However, in an interaction model sex differences became manifest under stressful circumstances. These patterns might provide clues for the male disadvantage in neonatal mortality and morbidity following preterm birth. However, due to the small sample size, the data should be seen as hypothesis generating.

Application of liquid chromatography coupled to high-resolution mass spectrometry to measure urinary cortisol in loose housed sows

Cortisol is the most common physiological parameter used to measure welfare in pigs. In field studies evaluating stress in individual pigs which are group housed, the collection of spontaneously voided urine is practical. The purpose of the study was to apply a liquid chromatography coupled to high-resolution mass spectrometry approach to observe the patterns of diurnal urinary cortisol excretion among loose sows of three herds. We applied the analytical method in spontaneously voided urine of thirty, repeatedly sampled within a day, multiparous sows of three Greek herds. We found the level of urinary cortisol being highest before morning feeding [geometric mean of urinary cortisol to creatinine ratio being 2.72 (95% confidence interval: 1.17, 6.30), 5.65 (3.15, 10.14) and 2.60 (1.50, 4.50) in sows of herds A, B, and C, respectively] and lowest at 19:00 h [0.56 (0.27, 1.18), 1.24 (0.74, 2.07), 0.88 (0.55, 1.44)]. However, the patterns of diurnal urinary cortisol excretion appeared different among herds.