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.

The Impact of Glucocorticoid Co-Secretion in Primary Aldosteronism on Thyroid Autoantibody Titers During the Course of Disease

Excess aldosterone is associated with the increased risk of cardio-/cerebrovascular events as well as metabolic comorbidities not only due to its hypertensive effect but also due to its proinflammatory action. Autonomous cortisol secretion (ACS) in the setting of primary aldosteronism (PA) is known to worsen cardiovascular outcome and potentially exhibit immunosuppressive effects. The aim of this study was to determine the impact of ACS status in patients with PA on kinetics of thyroid autoantibodies (anti-TPO, anti-TG) pre and post therapy initiation. Ninety-seven PA patients (43 unilateral, 54 with bilateral PA) from the database of the German Conn’s Registry were included. Anti-TPO and anti-TG levels were measured pre and 6–12 months post therapeutic intervention. Patients were assessed for ACS according to their 24- hour urinary cortisol excretion, late night salivary cortisol and low-dose dexamethasone suppression test. Abnormal test results in line with ACS were identified in 74.2% of patients with PA. Following adrenalectomy, significant increases in anti-TPO levels were observed in patients with at least one abnormal test (p = 0.049), adrenalectomized patients with at least two pathological ACS tests (p = 0.015) and adrenalectomized patients with pathologic dexamethasone suppression tests (p = 0.018). No antibody increases were observed in unilateral PA patients without ACS and in patients with bilateral PA receiving mineralocorticoid antagonist therapy (MRA). Our data are in line with an immunosuppressive effect of mild glucocorticoid excess in PA on thyroid autoantibody titers. This effect is uncovered by adrenalectomy, but not by MRA treatment.

SAT-LB76 Impact of Glucocorticoid Cosecretion in Primary Aldosteronism on Thyroid Autoantibody Titers During the Course of Disease

Context: Excess aldosterone is associated with the increased risk of cardio- and cerebrovascular events as well as metabolic comorbidities not only due to its hypertensive effect but also due to its proinflammatory action. Autonomous cortisol secretion (ACS) in the setting of primary aldosteronism (PA) is known to worsen cardiovascular outcome and potentially exhibit immunosuppressive effects.The aim of this study was to determine the impact of ACS status in patients with PA on kinetics of thyroid autoantibodies (anti-TPO, anti-TG) pre and post therapy initiation. Patients and Methods: 97 PA patients (43 with unilateral, 54 with bilateral PA) from the database of the German Conn’s Registry were included. Anti-TPO and anti-TG levels were measured pre and 6 to 12 months post therapeutic intervention. Patients were assessed for ACS according to their 24h urinary cortisol excretion, late night salivary cortisol and low-dose dexamethason suppression test. Results: Abnormal test results in line with ACS were identified in 74.2% of patients. Significant increases in anti-TPO levels were observed in adrenalectomized patients with at least one abnormal test (p = 0.049), adrenalectomized patients with at least two pathological ACS tests (p = 0.015) and adrenalectomized patients with pathologic dexamethasone suppression tests (p = 0.018). No antibody increases were observed in unilateral PA patients without ACS and in patients with bilateral PA receiving mineralocorticoid antagonist therapy. Conclusion: ACS appears to be a relevant factor in PA affecting thyroid autoimmune disease. The biochemical and clinical course maybe be exacerbated after resolution of hypercortisolism by adrenalectomy in PA.

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.