Hypercortisolism and altered glucose homeostasis in obese patients in the pre‐bariatric surgery assessment

Abstract

Aims Hypothalamus‐pituitary‐adrenal (HPA) axis hyperactivity was suggested to be associated with the metabolic syndrome (MS), obesity and diabetes. The aim of this study was to test whether hypercortisolism was associated with altered glucose homeostasis and insulin resistance, hypertension and dyslipidemia in a homogeneous population of obese patients. Materials/Methods In retrospective analysis of a set of data about obese patients attending the outpatient service of a single obesity centre between January 2013 and January 2020, 884 patients with BMI >30 kg/m2 were segregated in two subgroups: patients with urinary free cortisol (UFC) higher than normal (UFC+; n = 129) or within the normal range (UFC−; n = 755). Results The overall prevalence of UFC+ was 14.6% and double test positivity (morning cortisol >1.8 mcg/dL following overnight dexamethasone suppression test, ODST) was detected in 1.0% of patients. Prediabetes (OR 1.74; 95%CI 1.13‐2.69; p = 0.012) and diabetes (OR 2.03; 95%CI 1.21‐3.42; p = 0.008) were associated with higher risk of UFC+ when analysis was adjusted for confounding variables. Conversely, hypertension and dyslipidemia were not related to UFC+. Within the individuals with normal FPG and HbA1c, those with higher estimated insulin resistance (HOMA2‐IR) maintained a higher risk of UFC+ (OR 2.84, 95%CI 1.06‐7.63; p = 0.039) and this relationship was weakened only when the body fat percentage was included into the model. Conclusions In obese patients, hypercortisolism was more frequent across the entire spectrum of altered glucose homeostasis including the very early stages; this relation could not be detected for the other criteria of the MS, as waist, hypertension and atherogenic dyslipidemia.

High plasma renin activity associates with obesity-related diabetes and arterial hypertension, and predicts persistent hypertension after bariatric surgery

“…In this study, changes in ferritin levels among NGT, IGT, and DM were not accompanied by changes in transferrin, iron, and albumin. We should not forget the possible role of the hypothalamic-pituitary-adrenal axis in obese individuals [ 34 – 36 ]; in this study, free urinary cortisol was also decreased after BS. Our results are consistent with the demonstrated existence of active cross-talks between angiotensin II and insulin signaling, as well as a role of sub inflammation in contributing to insulin resistance in obese hypertensive subjects [ 37 – 41 ].…”

GluN2A/ERK/CREB Signaling Pathway Involved in Electroacupuncture Regulating Hypothalamic-Pituitary-Adrenal Axis Hyperactivity

“…Unfortunately, its dysfunction induced by surgery, anesthesia, anxiety, and pain often results in endocrine disorders and immunosuppression ( Kim, 2017 ; Tafet and Nemeroff, 2020 ). With the continuation of HPA axis hyperactivity, diseases such as diabetes ( Miranda et al, 2016 ), high blood pressure ( Muraca et al, 2021 ), and depression ( Li et al, 2020 ) will inevitably appear. To simulate HPA axis hyperactivity in clinical situations, the HT mouse model was employed in the present study.…”

Across-species benefits of adrenalectomy on congenital generalized lipoatrophic diabetes: a review

“…Muraca et al., 2020, reported their findings on 884 obese subjects studied before subjecting them to bariatric surgery ( 33 ). A fraction of 129 patients (14.6%) had elevated UFC levels.…”