Introduction: 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. Methods: 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). Results: 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 (p = 0.003), more obese (BMI: p = 0.040), had lower diastolic blood pressure ([DBP]; p = 0.012), lower total (p = 0.032) and LDL cholesterol (p = 0.021), fasting (p = 0.049) and 2-h glycemia (p = 0.028), 2-h insulinemia (p = 0.020), and HbA1c (p #x3c; 0.001), and a higher estimated glomerular filtration rate (eGFR) (p #x3c; 0.001). The glucose (p #x3c; 0.001) and insulin (p = 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, p = 0.004) and overall glucose tolerance (oral disposition index, beta = 0.090, p = 0.011), and negatively with HbA1c (beta = −0.179, p #x3c; 0.001), 2-h glycemia (beta = −0.075, p = 0.032), AUC glucose (beta = −0.103, p = 0.002), and DBP (beta = −0.139, p #x3c; 0.001). HbA1c, BW, and DBP remained significant after multivariable analysis. Discussion/Conclusion: Despite being more obese, patients with higher cortisol excretion have a more favorable metabolic profile. These results deserve further attention regarding the respective mechanisms.
Obes Facts

中文翻译：

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非糖尿病病态肥胖患者皮质醇排泄与体重和代谢参数的关系

介绍：皮质醇参与糖异生和葡萄糖利用的调节。在病态肥胖症 (MO) 中，皮质醇排泄与代谢参数的关联尚未得到充分表征。在我们的研究中，我们评估了患有 MO 的非糖尿病受试者的皮质醇排泄及其对葡萄糖代谢的影响。方法：我们纳入了 1,249 名患有 MO 的非糖尿病患者（79.8% 为女性，平均 BMI 44.9 ± 6.5 kg/m ²，平均年龄 38 ± 11 岁）。评估人体测量数据和心血管危险因素，并进行口服葡萄糖耐量试验以计算胰岛素抵抗。连续 2 天（24 小时尿样）评估皮质醇排泄。结果：关于皮质醇排泄，患者被分为 3 个三分位数（尿皮质醇≤51.6，#x3e；51.6 和 #x3c；117.6，≥117.6 μg/24 h，分别）。在最高三分位患者更年轻（p = 0.003），更肥胖（BMI：p = 0.040），具有较低的舒张压（[DBP]; p = 0.012），降低总（p = 0.032）和低密度脂蛋白胆固醇（p = 0.021)、禁食 ( p = 0.049) 和 2 小时血糖 ( p = 0.028)、2 小时胰岛素血症( p = 0.020) 和 HbA1c ( p #x3c；0.001)，以及更高的估计肾小球滤过率 (eGFR) ) ( p #x3c; 0.001)。葡萄糖（p#x3c; 0.001) 和胰岛素 ( p = 0.011) 曲线下面积 (AUC) 也较低。根据年龄、性别和 eGFR 调整后的尿皮质醇排泄量与体重（BW，β = 0.076，p = 0.004）和总体葡萄糖耐量（口服处置指数，β = 0.090，p = 0.011）呈正相关，与 HbA1c 呈负相关(beta = -0.179, p #x3c; 0.001), 2-h 血糖 (beta = -0.075, p = 0.032), AUC 葡萄糖 (beta = -0.103, p = 0.002), 和 DBP (beta = -0.139, p #x3c；0.001）。多变量分析后，HbA1c、BW 和 DBP 仍然显着。讨论/结论：尽管更肥胖，但皮质醇排泄量较高的患者具有更有利的代谢特征。这些结果值得进一步关注各自的机制。
肥胖事实