Patients with the metabolic syndrome and a disturbed cortisol balance display more microalbuminuria

Abstract

T he objective of this study was to investigate whether patients with the metabolic syndrome (MetS) and an imbalance in cortisol metabolism express increased urinary albumin excretion compared to those patients with metabolic syndrome alone.Seventy-four patients with MetS were evaluated using a low-dose dexamethasone suppression test (LDDST) to identify disturbed cortisol balance (cortisol levels > 50 nmol/L after LDDST). The level of albumin in the urine was also evaluated.Disturbed cortisol balance was found in 8% of all evaluated patients with MetS. Microalbuminuria was present significantly more often (p<0.01) in those patients with MetS and an imbalance in cortisol metabolism compared with patients suffering MetS alone (urine albumin: 210 mg/L vs. 26 mg/L, respectively, p<0.01).A substantial percentage of patients with MetS had inappropriate cortisol homeostasis. Of importance, excretion of urinary albumin was increased in these patients. This observation may indicate that this subgroup within the MetS population has a higher cardiovascular risk and possible increased endothelial dysfunction, with a subsequent need for stricter control to prevent cardiovascular morbidity and mortality.

The Association Of Serum Cortisol Level With Microalbuminuria In Patients With Type 2 Diabetes And Prediabetes

“…The present study demonstrated a relationship of increased serum cortisol and the presence of microalbuminuria in subjects with T2DM or prediabetes. Previously, a study showed that patients with MetS and disturbed cortisol balance display more microalbuminuria 10 . In patients with T2DM, increased hypothalamic-pituitary-adrenal axis (HPA) activity was found to be related to the presence of some diabetic chronic complications, and the level of cortisol secretion was linked with the number of diabetic complications.…”

“…Besides the traditional cardiometabolic factors, cortisol secretion is also suggested to correlate with renal function in a few studies 9 , 10 . Serum cortisol level was negatively correlated with eGFR levels in patients with essential hypertension.…”

“…Serum cortisol level was negatively correlated with eGFR levels in patients with essential hypertension. Non-suppressing cortisol with a low-dose dexamethasone suppression test was found to be associated with the presence of microalbuminuria in patients with metabolic syndrome (MetS) 10 . But evidence is lacking on this topic in diabetic patients, In this study, we aimed to evaluate the HPA activity and the urinary albumin levels, so as to determine whether there is an association of cortisol secretion with microalbuminuria.…”

Hypothalamic-pituitary-adrenal axis activity is associated with the prevalence of chronic kidney disease in diabetic patients

“…Additionally, UAE declined profoundly, independent of changes in blood pressure and plasma glucose levels, in all these patients after amelioration of hypercortisolism [7]. Patients having metabolic syndrome with hypercortisolism displayed more microalbuminuria than did those without hypercortisolism, even though there were no differences in blood pressure, plasma glucose, and serum lipids between the two groups [8]. These clinical evidences indicate that endogenous hypercortisolism caused by enhanced hypothalamic-pituitary-adrenal (HPA) axis activity itself could increase UAE and eventually lead to CKD independent of blood pressure and metabolic factors such as plasma glucose and serum lipids.…”

Associations among systemic blood pressure, microalbuminuria and albuminuria in dogs affected with pituitary- and adrenal-dependent hyperadrenocorticism

“…Microalbuminuria assays are more sensitive to albumin loss in the urine than the common urine dipstick, and urinary protein:creatinine ratio tests can detect protein loss through the urine with lower limits-of-detection than urine dipsticks. Microalbuminuria is used as an indicator in screening for early-stage renal and cardiovascular diseases in humans [ 12 , 14 , 17 , 20 , 21 ]. It is a well-known risk factor associated with deteriorated cardiovascular mortality and diabetic nephropathy in human beings [ 12 - 14 , 17 ].…”