The adrenal and the metabolic syndrome

Abstract

This review discusses the possible interrelationships between adrenal steroid hormones and the metabolic syndrome. Abnormal regulation of the hypothalamic-pituitary-adrenal axis has been proposed. Studies in the United Kingdom associated the metabolic syndrome with low birth weight and hyperactivity of the entire axis. In Italy, increased pituitary responsiveness to stimulation with vasopressin and corticotrophin-releasing hormone was demonstrated in women with central obesity. Swedish researchers have reported that increased stress responses of the axis correlated with a less variable but decreased cortisol level. An allele of the glucocorticoid receptor was also associated with various components of the metabolic syndrome. Evidence also suggests that central obesity is associated with an increased peripheral conversion of cortisol to cortisone and subsequent feedback stimulation of the axis. On the other hand, central fat may have an increased local metabolism in the direction of cortisol. Roles for dehydroepiandrosterone and aldosterone in the syndrome have also been proposed.

Stress and the Metabolic Syndrome

“…18 The complexity of this field of research is underscored by findings of altered glucocorticoid metabolism in obesity and local generation of cortisol in visceral adipose tissue. 19 The elevation of cortisol metabolite excretion among Whitehall cases is in line with previous findings, 13 and there are interesting associations between psychosocial factors, stress, and the HPA axis that may well be of etiologic importance in the metabolic syndrome.…”

Cortisol, Testosterone, and Coronary Heart Disease

“…54 With respect to the insulin resistance syndrome, several studies have found that early-morning plasma cortisol levels (ie, measures directly comparable to those in the present study) were correlated with various measures of the syndrome and its subcomponents, 55,56 and other studies with different indices of cortisol metabolism provide supportive evidence. 57,58 With respect to circulating testosterone levels, the picture is mixed, with testosterone either having no association or an inverse association with CHD risk. 59 -61 One randomized, placebo-controlled trial produced a reduction in angina symptoms in participants randomized to testosterone undecanoate, †Systolic blood pressure, triglycerides (log transformed), cholesterol (log transformed), HDL cholesterol (log transformed), body mass index, fasting glucose (log transformed), and fasting insulin (log transformed).…”

Massive Weight Loss Decreases Corticosteroid-Binding Globulin Levels and Increases Free Cortisol in Healthy Obese Patients

“…The HPA axis controls the secretion of cortisol with excessive secretion being inhibited by negative feedback. Several studies suggest that abnormalities in cortisol action and HPA axis control may be a factor that links disturbances of carbohydrate metabolism (which characterize insulin resistance) and obesity (5)(6). In obesity, estimation of plasma cortisol does not reflect the function of the HPA axis (7), and levels of cortisol in obese patients have been reported to be normal (8), low (9), or increased (10).…”