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Open Access Research article

High-end normal adrenocorticotropic hormone and cortisol levels are associated with specific cardiovascular risk factors in pediatric obesity: a cross-sectional study

Flavia Prodam123*, Roberta Ricotti1, Valentina Agarla1, Silvia Parlamento1, Giulia Genoni1, Caterina Balossini1, Gillian Elisabeth Walker1, Gianluca Aimaretti2, Gianni Bona13 and Simonetta Bellone123

Author Affiliations

1 SCDU of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale 'A. Avogadro', Via Solaroli 17, Novara, 28100, Italy

2 Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale 'A. Avogadro', Via Solaroli 17, Novara, 28100, Italy

3 Interdisciplinary Center for Obesity Study (ICOS), Università del Piemonte Orientale 'A. Avogadro', Via Solaroli 17, Novara, 28100, Italy

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BMC Medicine 2013, 11:44  doi:10.1186/1741-7015-11-44

Published: 20 February 2013

Abstract

Background

The 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.

Methods

This 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.

Results

ACTH 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.

Conclusions

In 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.

Keywords:
ACTH; cardiovascular risk; cortisol; glucose; hypertension; lipids; obesity; pediatric