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Massive weight loss decreases corticosteroid-binding globulin levels and increases free cortisol in healthy obese patients: an adaptive phenomenon?
Diabetes Care. 2007 Jun; 30(6):1494-500.DC

Abstract

OBJECTIVE

Obesity, insulin resistance, and weight loss have been associated with changes in hypothalamic-pituitary-adrenal (HPA) axis. So far, no conclusive data relating to this association are available. In this study, we aim to investigate the effects of massive weight loss on cortisol suppressibility, cortisol-binding globulin (CBG), and free cortisol index (FCI) in formerly obese women.

RESEARCH DESIGN AND METHODS

Ten glucose-normotolerant, fertile, obese women (BMI >40 kg/m2, aged 38.66 +/- 13.35 years) were studied before and 2 years after biliopancreatic diversion (BPD) when stable weight was achieved and were compared with age-matched healthy volunteers. Cortisol suppression was evaluated by a 4-mg intravenous dexamethasone suppression test (DEX-ST). FCI was calculated as the cortisol-to-CBG ratio. Insulin sensitivity was measured by an euglycemic-hyperinsulinemic clamp, and insulin secretion was measured by a C-peptide deconvolution method.

RESULTS

No difference was found in cortisol suppression after DEX-ST before or after weight loss. A decrease in ACTH was significantly greater in control subjects than in obese (P = 0.05) and postobese women (P < or = 0.01) as was the decrease in dehydroepiandrosterone (P < or = 0.05 and P < or = 0.01, respectively). CBG decreased from 51.50 +/- 12.76 to 34.33 +/- 7.24 mg/l (P < or = 0.01) following BPD. FCI increased from 11.15 +/- 2.85 to 18.16 +/- 6.82 (P < or = 0.05). Insulin secretion decreased (52.04 +/- 16.71 vs. 30.62 +/- 16.32 nmol/m(-2); P < or = 0.05), and insulin sensitivity increased by 163% (P < or = 0.0001). Serum CBG was related to BMI (r(0) = 0.708; P = 0.0001), body weight (r(0) = 0.643; P = 0.0001), body fat percent (r(0) = 0.462; P = 0.001), C-reactive protein (r(0) = 0.619; P = 0.004), and leptin (r(0) = 0.579; P = 0.007) and negatively to M value (r(0) = -0.603; P = 0.005).

CONCLUSIONS

After massive weight loss in morbidly obese subjects, an increase of free cortisol was associated with a simultaneous decrease in CBG levels, which might be an adaptive phenomenon relating to environmental changes. This topic, not addressed before, adds new insight into the complex mechanisms linking HPA activity to obesity.

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Authors+Show Affiliations

Manco M
Liver Unit, Bambino Gesù Hospital and Research Institute, Rome, Italy. melaniamanco@tiscali.it
Fernández-Real JM
No affiliation info available
Valera-Mora ME
No affiliation info available
Déchaud H
No affiliation info available
Nanni G
No affiliation info available
Tondolo V
No affiliation info available
Calvani M
No affiliation info available
Castagneto M
No affiliation info available
Pugeat M
No affiliation info available
Mingrone G
No affiliation info available

MeSH

Adipose TissueAdultBariatric SurgeryBlood GlucoseBlood PressureBody SizeCholesterolDexamethasoneHuman Growth HormoneHumansHydrocortisoneLeptinMiddle AgedObesityReference ValuesTranscortinWeight Loss

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17526821

Citation

Manco, Melania, et al. "Massive Weight Loss Decreases Corticosteroid-binding Globulin Levels and Increases Free Cortisol in Healthy Obese Patients: an Adaptive Phenomenon?" Diabetes Care, vol. 30, no. 6, 2007, pp. 1494-500.
Manco M, Fernández-Real JM, Valera-Mora ME, et al. Massive weight loss decreases corticosteroid-binding globulin levels and increases free cortisol in healthy obese patients: an adaptive phenomenon? Diabetes Care. 2007;30(6):1494-500.
Manco, M., Fernández-Real, J. M., Valera-Mora, M. E., Déchaud, H., Nanni, G., Tondolo, V., Calvani, M., Castagneto, M., Pugeat, M., & Mingrone, G. (2007). Massive weight loss decreases corticosteroid-binding globulin levels and increases free cortisol in healthy obese patients: an adaptive phenomenon? Diabetes Care, 30(6), 1494-500.
Manco M, et al. Massive Weight Loss Decreases Corticosteroid-binding Globulin Levels and Increases Free Cortisol in Healthy Obese Patients: an Adaptive Phenomenon. Diabetes Care. 2007;30(6):1494-500. PubMed PMID: 17526821.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Massive weight loss decreases corticosteroid-binding globulin levels and increases free cortisol in healthy obese patients: an adaptive phenomenon? AU - Manco,Melania, AU - Fernández-Real,José M, AU - Valera-Mora,Maria E, AU - Déchaud,Henri, AU - Nanni,Giuseppe, AU - Tondolo,Vincenzo, AU - Calvani,Menotti, AU - Castagneto,Marco, AU - Pugeat,Michel, AU - Mingrone,Geltrude, PY - 2007/5/29/pubmed PY - 2007/6/15/medline PY - 2007/5/29/entrez SP - 1494 EP - 500 JF - Diabetes care JO - Diabetes Care VL - 30 IS - 6 N2 - OBJECTIVE: Obesity, insulin resistance, and weight loss have been associated with changes in hypothalamic-pituitary-adrenal (HPA) axis. So far, no conclusive data relating to this association are available. In this study, we aim to investigate the effects of massive weight loss on cortisol suppressibility, cortisol-binding globulin (CBG), and free cortisol index (FCI) in formerly obese women. RESEARCH DESIGN AND METHODS: Ten glucose-normotolerant, fertile, obese women (BMI >40 kg/m2, aged 38.66 +/- 13.35 years) were studied before and 2 years after biliopancreatic diversion (BPD) when stable weight was achieved and were compared with age-matched healthy volunteers. Cortisol suppression was evaluated by a 4-mg intravenous dexamethasone suppression test (DEX-ST). FCI was calculated as the cortisol-to-CBG ratio. Insulin sensitivity was measured by an euglycemic-hyperinsulinemic clamp, and insulin secretion was measured by a C-peptide deconvolution method. RESULTS: No difference was found in cortisol suppression after DEX-ST before or after weight loss. A decrease in ACTH was significantly greater in control subjects than in obese (P = 0.05) and postobese women (P < or = 0.01) as was the decrease in dehydroepiandrosterone (P < or = 0.05 and P < or = 0.01, respectively). CBG decreased from 51.50 +/- 12.76 to 34.33 +/- 7.24 mg/l (P < or = 0.01) following BPD. FCI increased from 11.15 +/- 2.85 to 18.16 +/- 6.82 (P < or = 0.05). Insulin secretion decreased (52.04 +/- 16.71 vs. 30.62 +/- 16.32 nmol/m(-2); P < or = 0.05), and insulin sensitivity increased by 163% (P < or = 0.0001). Serum CBG was related to BMI (r(0) = 0.708; P = 0.0001), body weight (r(0) = 0.643; P = 0.0001), body fat percent (r(0) = 0.462; P = 0.001), C-reactive protein (r(0) = 0.619; P = 0.004), and leptin (r(0) = 0.579; P = 0.007) and negatively to M value (r(0) = -0.603; P = 0.005). CONCLUSIONS: After massive weight loss in morbidly obese subjects, an increase of free cortisol was associated with a simultaneous decrease in CBG levels, which might be an adaptive phenomenon relating to environmental changes. This topic, not addressed before, adds new insight into the complex mechanisms linking HPA activity to obesity. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/17526821/Massive_weight_loss_decreases_corticosteroid_binding_globulin_levels_and_increases_free_cortisol_in_healthy_obese_patients:_an_adaptive_phenomenon L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=17526821 DB - PRIME DP - Unbound Medicine ER -