THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN OBESE WOMEN WITH DIFFERENT PATTERNS OF BODY-FAT DISTRIBUTION
THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN OBESE WOMEN WITH DIFFERENT PATTERNS OF BODY-FAT DISTRIBUTION
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DOI：
10.1210/jc.77.2.341
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发表时间：
1993-08-01
影响因子：
5.8
通讯作者：
BARBARA, L
中科院分区：
文献类型：
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作者：
PASQUALI, R;CANTOBELLI, S;BARBARA, L
为了研究腹部肥胖的肥胖受试者是否可以以下丘脑-垂体-肾上腺轴的过度活跃为特征，我们检查了两组肥胖女性，其中腰臀比（WHR）低于0.80（n = 13），因此具有外周体脂肪分布（P-BFD），或WHR高于0.85（n = 12），因此具有腹部体脂肪分布（A-BFD）。一组7名正常体重的健康女性作为对照组。所有受试者均接受以下方案研究，包括1）每日尿游离皮质醇排泄率的测量; 2）CRF检测（人CRF，1 μ g/kg BW，静脉推注），定期采集血样用于ACTH和皮质醇测定;和3）ACTH试验，通过以90分钟的间隔施用两次促肾上腺皮质激素（Synacthen，0.2 μ g/kg BW，iv）进行，并采集血样用于皮质醇测定。每个妇女也有一个对照盐水研究。ACTH和皮质醇的基础水平显着上升后，CRF管理在所有组，但这种增加是显着高于在P-BFD和对照妇女。CRF试验中皮质醇和ACTH的增量面积呈显著相关（r = 0.502），而与WHR无相关性。尽管A-BFD组ACTH试验后皮质醇增加高于其他组，但这些差异仅在试验期间60分钟时以及应用重复测量分析时才具有显著性。相反，ACTH试验后皮质醇面积的增加在三组中没有显著差异。此外，它与CRF试验后皮质醇面积增加或WHR值无显著相关性。然而，A-BFD中每日尿游离皮质醇排泄率（每克肌酸酐）显着高于P-BFD和对照女性。因此，这些结果表明，肥胖妇女A-BFD可能有下丘脑-垂体-肾上腺轴的过度活跃。这种异常可能起源于中枢，由于CRF或ACTH分泌过多;或者，它可能代表继发于功能性皮质醇抵抗状态的适应性现象。
To investigate whether obese subjects with abdominal obesity may be characterized by hyperactivity of the hypothalamic-pituitary-adrenal axis, we examined two groups of obese women with a waist to hip ratio (WHR) lower than 0.80 (n = 13), therefore having peripheral body fat distribution (P-BFD), or a WHR higher than 0.85 (n = 12), thus having abdominal body fat distribution (A-BFD). A group of seven normal weight healthy women served as controls. All subjects underwent the following protocol study that included 1) measurement of daily urinary free cortisol excretion rate; 2) a CRF test (human CRF, 1 mug/kg BW, as iv bolus), with blood samples taken at regular intervals for ACTH and cortisol determination; and 3) an ACTH test, performed by administering two boli of ACTH (Synacthen, 0.2 mug/kg BW, iv), at 90-min intervals, with blood samples taken for cortisol determination. Each woman also had a control saline study.Basal levels of both ACTH and cortisol rose significantly after CRF administration in all groups, but this increase was significantly higher in A-BFD than in P-BFD and control women. A significant correlation was found between the incremental area of cortisol and that of ACTH during the CRF test (r = 0.502), but not between these parameters and WHR values. Although the cortisol increase after the ACTH test was higher in A-BFD than in the other groups, these differences were only significant at 60 min during the test and when the analysis for repeated measures was applied. On the contrary, the incremental cortisol area after the ACTH test was not significantly different in the three groups. Moreover, it was not significantly correlated with the incremental cortisol area after CRF test or WHR values. Daily urinary free cortisol excretion rates (per g creatinine), however, were significantly higher in A-BFD than in P-BFD and control women. These results, therefore, suggest that obese women with A-BFD may have hyperactivity of the hypothalamic-pituitary-adrenal axis. This abnormality could be central in origin, due to hypersecretion of CRF or ACTH; alternatively, it could represent an adaptive phenomenon secondary to a state of functional cortisol resistance.