High-end normal adrenocorticotropic hormone and cortisol levels are associated with specific cardiovascular risk factors in pediatric obesity: a cross-sectional study
High-end normal adrenocorticotropic hormone and cortisol levels are associated with specific cardiovascular risk factors in pediatric obesity: a cross-sectional study
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高端正常促肾上腺皮质激素和皮质醇水平与儿童肥胖的特定心血管危险因素相关：一项横断面研究
作者：
F. Prodam;R. Ricotti;V. Agarla;S. Parlamento;G. Genoni;C. Balossini;G. Walker;G. Aimaretti;G. Bona;S. Bellone
研究背景下丘脑-垂体-肾上腺（HPA）轴，特别是皮质醇，被报道参与成人和特定青少年人群中肥胖相关的代谢紊乱。本研究的目的是探讨早晨促肾上腺皮质激素（ACTH）和皮质醇水平和心血管危险因素超重或肥胖的高加索儿童和青少年之间的关联。MethodsThis横断面研究450肥胖儿童和青少年（4至18岁）在三级转诊中心进行。评估ACTH、皮质醇、心血管危险因素（空腹和攻毒后血糖、高密度脂蛋白（HDL）-胆固醇、低密度脂蛋白（LDL）-胆固醇、甘油三酯和高血压）和胰岛素抵抗。所有的分析进行了校正混杂因素（性别，年龄，青春期，体重指数），优势比determined.ResultsACTH和皮质醇水平呈正相关，收缩压和舒张压，甘油三酯，空腹血糖和胰岛素抵抗。皮质醇，而不是促肾上腺皮质激素，也与LDL-胆固醇呈正相关。调整混杂因素后，ACTH和口服葡萄糖耐量试验后2小时葡萄糖之间的关联被揭示。根据心血管危险因素分层并调整可能的混杂因素后，甘油三酯≥第90百分位数（P <0.02）和空腹血糖或糖耐量受损（P <0.001）的受试者ACTH水平显著较高。血压≥ 95百分位数和LDL-胆固醇≥ 90百分位数的受试者皮质醇水平较高。总体而言，最高的三分位数的ACTH（>5.92 pmol/l）和皮质醇（>383.5 nmol/l），虽然在正常范围内与心血管危险因素的增加，在这个population.ConclusionsIn肥胖的儿童和青少年，高上午ACTH和皮质醇水平与心血管危险因素。高ACTH水平与高甘油三酯水平和高血糖症相关，而高皮质醇与高血压和高LDL-胆固醇相关。这些特定的关系表明HPA轴可能通过复杂的机制导致肥胖症的代谢障碍，值得进一步研究。
BackgroundThe hypothalamic-pituitary-adrenal (HPA) axis, and in particular cortisol, has been reported to be involved in obesity-associated metabolic disturbances in adults and in selected populations of adolescents. The aim of this study was to investigate the association between morning adrenocorticotropic hormone (ACTH) and cortisol levels and cardiovascular risk factors in overweight or obese Caucasian children and adolescents.MethodsThis cross-sectional study of 450 obese children and adolescents (aged 4 to 18 years) was performed in a tertiary referral center. ACTH, cortisol, cardiovascular risk factors (fasting and post-challenge glucose, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, and hypertension) and insulin resistance were evaluated. All analyses were corrected for confounding factors (sex, age, puberty, body mass index), and odds ratios were determined.ResultsACTH and cortisol levels were positively associated with systolic and diastolic blood pressure, triglycerides, fasting glucose and insulin resistance. Cortisol, but not ACTH, was also positively associated with LDL-cholesterol. When adjusted for confounding factors, an association between ACTH and 2 h post-oral glucose tolerance test glucose was revealed. After stratification according to cardiovascular risk factors and adjustment for possible confounding factors, ACTH levels were significantly higher in subjects with triglycerides ≥90th percentile (P <0.02) and impaired fasting glucose or glucose tolerance (P <0.001). Higher cortisol levels were found in subjects with blood pressure ≥95th percentile and LDL-cholesterol ≥90th percentile. Overall, the highest tertiles of ACTH (>5.92 pmol/l) and cortisol (>383.5 nmol/l) although within the normal range were associated with increases in cardiovascular risk factors in this population.ConclusionsIn obese children and adolescents, high morning ACTH and cortisol levels are associated with cardiovascular risk factors. High ACTH levels are associated with high triglyceride levels and hyperglycemia, while high cortisol is associated with hypertension and high LDL-cholesterol. These specific relationships suggest complex mechanisms through which the HPA axis may contribute to metabolic impairments in obesity, and merit further investigations.
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