Cortisol Per M&in,

Secretion

in Relation to Body Fat Distribution Premenopausal Women

Niklas Darin, Teiko Amemiya,

Bjdrn Andersson,

in Obese

Sverker Jern, and Per Bjijrntorp

Urinary cortisol output and serum cortisol concentrations were measured in the steady state, under “field” conditions, and during standardized inhibitory and stimulatory tests in premenopausal, obese women, and were analyzed in relation to adipose tissue distribution. Urinary cortisol output was increased under field conditions in women with an elevated waist to hip circumference ratio (WHR) and, in particular, in women with a large abdominal sagittal diameter, indicating visceral fat accumulation. However, dexamethasone inhibition of cortisol secretion was normal. Stimulation with cotticotropin analogue and with physical (cold-pressor test) or mental (color-word or mathematic) stress tests also showed elevated responses of serum cortisol, but not of prolactin or growth hormone concentrations. It is suggested that women with visceral fat accumulation have elevated cortisol secretion due to an increased sensitivity along the hypothalamic-pituitary-adrenal axis, and that this may be causing their abnormal fat depot distribution. Copyright 0 1992 by W. B. S&den Company

_

C

ORTISOL SECRETION in human obesity is a frequently studied problem.i-4 Different results have been obtained, but most reports show an elevated cortisol secretion with increasing degree of obesity.1,2 However, this increase disappears when corrected for creatinine output, suggesting that it is mainly due to an elevated lean body mass in obese subjects.3,4 Previous and recent studies have shown marked differences in metabolic variables and in risk for disease in obese humans with different distribution of adipose tissue.‘,h In addition, sex steroid hormone secretions have been reported to vary with body fat distribution in obesity.7-y However, cortisol has attracted less attention from this aspect. In early studies, it was observed that urinary excretion of 17-OH and 17-ketosteroids was increased in women with android obesity.7 Furthermore, cortisol and androstenedione and testosterone concentrations in blood were elevated after stimulation with a corticotropin analogue in android obese women in comparison with gynoid obese women.s Single measurements of plasma cortisol concentrations have been reported not to show any differences between obese women with widely varying waist to hip circumference ratios (WHR),9 a measurement of body fat distribution. However, androstenedione concentrations have been found to be proportional to the WHR.‘O In view of its importance, we decided to reexamine this problem in obese premenopausal women with different body fat distribution. In particular, we wanted to elucidate cortisol secretion not only in the steady state, but also after stimulation by everyday environmental factors, and also by standardized laboratory tests measuring the activity along the hypothalamic-pituitary-adrenal axis.

From the Department of Medicine I and Wallenberg Laboratory, Sahlgren’s Hospital, Gothenburg; and the Department of Clinical Physiologv &a Hospital, Universityof Gothenburg Sweden. Supported by grants from the Swedish Medical Research Council (Project No. 251) and the Society of Medicine, Giiteborg Sweden. Present address: Teiko Amemiya, Diabetes Center, Tokyo Womens’ Medical College* 8-l Kawada-cho, Shinjuku-ku. Tokyo 162. Japan. Address reprint requests to Per Bji_imtorp, MD, Department of Medicine, Sahlgren > Hospital, S-413 45 GBteborg Sweden. Copyright 0 1992 bv W.B. Saunders Company 0026-0495/92/4108-0013$03.0010

882

MATERIALS

AND METHODS

A total of 87 obese women below the age of 45 years were studied. They were recruited consecutively from an outpatient clinic for obesity treatment and were included in the study if they were weight stable and not on any diet for the preceding 3 months as judged by history and body weight recordings at the clinic or by the patients (variations of

Cortisol secretion in relation to body fat distribution in obese premenopausal women.

Urinary cortisol output and serum cortisol concentrations were measured in the steady state, under "field" conditions, and during standardized inhibit...
570KB Sizes 0 Downloads 0 Views