Diabetes Metab J.  2012 Jun;36(3):245-250. 10.4093/dmj.2012.36.3.245.

The Association between Midnight Salivary Cortisol and Metabolic Syndrome in Korean Adults

• Jang YM
• Lee EJ
• Kim DL
• Kim SK
• Song KH

• KMID: 2281406
• DOI: http://doi.org/10.4093/dmj.2012.36.3.245

Abstract

BACKGROUND
The common characteristics of metabolic syndrome (MetS) and Cushing's syndrome suggest that excess cortisol may be involved in the pathogenesis of MetS. Salivary cortisol measurements are simple and can be surrogates for plasma free cortisol, which is the most biologically active form. We evaluated the association between levels of midnight salivary cortisol and MetS in Korean adults.
METHODS
A total of 46 subjects, aged 20 to 70 years, who visited the Health Care Center at Konkuk University Hospital from August 2008 to August 2009 were enrolled. We compared the levels of midnight salivary cortisol in subjects with MetS with those in subjects without MetS. We analyzed the associations between midnight salivary cortisol levels and components of MetS.
RESULTS
Midnight salivary cortisol levels were higher in the MetS group (70+/-42.4 ng/dL, n=12) than that in the group without MetS (48.1+/-36.8 ng/dL, n=34) (P=0.001). Positive correlations were observed between midnight salivary cortisol levels and waist circumference, fasting blood glucose, and homeostasis model assessment of insulin resistance. The risk for MetS was significantly higher in subjects with midnight salivary cortisol levels > or =100 ng/dL than in those with levels <50 ng/dL (odds ratio, 5.9; 95% confidence interval, 2.35 to 36.4).
CONCLUSION
The results showed a positive correlation between midnight salivary cortisol levels and MetS, suggesting that hypercortisolism may be related to MetS.

Keyword

Corticosteroid; Insulin resistance; Metabolic syndrome

MeSH Terms

Adult
Aged
Blood Glucose
Cushing Syndrome
Delivery of Health Care
Fasting
Homeostasis
Humans
Hydrocortisone
Insulin Resistance
Plasma
Waist Circumference
Blood Glucose
Hydrocortisone

Reference

1. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005. 366:1059–1062.

2. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988. 37:1595–1607.

3. Alexander CM, Landsman PB, Teutsch SM, Haffner SM. Third National Health and Nutrition Examination Survey (NHANES III). National Cholesterol Education Program (NCEP). NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes. 2003. 52:1210–1214.

4. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002. 287:356–359.

5. Kwon HS, Park YM, Lee HJ, Lee JH, Choi YH, Ko SH, Lee JM, Kim SR, Kang SY, Lee WC, Ahn MS, Noh JH, Kang JM, Kim DS, Yoon KH, Cha BY, Lee KW, Kang SK, Son HY. Prevalence and clinical characteristics of the metabolic syndrome in middle-aged Korean adults. Korean J Intern Med. 2005. 20:310–316.

6. Won JC, Park JY, Song KH, Lee WJ, Koh EH, Nam-Goong IS, Han SM, Lee MS, Kim MS, Lee KU. Changes in the prevalence of metabolic syndrome in a rural area of Korea defined by two criteria, revised National Cholesterol Education Program and International Diabetes Federation. J Korean Diabetes Assoc. 2007. 31:284–292.

7. Krikorian A, Khan M. Is metabolic syndrome a mild form of Cushing's syndrome? Rev Endocr Metab Disord. 2010. 11:141–145.

8. Park SB, Blumenthal JA, Lee SY, Georgiades A. Association of cortisol and the metabolic syndrome in Korean men and women. J Korean Med Sci. 2011. 26:914–918.

9. Vilar L, Freitas MC, Naves LA, Canadas V, Albuquerque JL, Botelho CA, Egito CS, Arruda MJ, Silva LM, Arahata CM, Agra R, Lima LH, Azevedo M, Casulari LA. The role of non-invasive dynamic tests in the diagnosis of Cushing's syndrome. J Endocrinol Invest. 2008. 31:1008–1013.

10. Viardot A, Huber P, Puder JJ, Zulewski H, Keller U, Muller B. Reproducibility of nighttime salivary cortisol and its use in the diagnosis of hypercortisolism compared with urinary free cortisol and overnight dexamethasone suppression test. J Clin Endocrinol Metab. 2005. 90:5730–5736.

11. Putignano P, Toja P, Dubini A, Pecori Giraldi F, Corsello SM, Cavagnini F. Midnight salivary cortisol versus urinary free and midnight serum cortisol as screening tests for Cushing's syndrome. J Clin Endocrinol Metab. 2003. 88:4153–4157.

12. Luthold WW, Marcondes JA, Wajchenberg BL. Salivary cortisol for the evaluation of Cushing's syndrome. Clin Chim Acta. 1985. 151:33–39.

13. Laudat MH, Cerdas S, Fournier C, Guiban D, Guilhaume B, Luton JP. Salivary cortisol measurement: a practical approach to assess pituitary-adrenal function. J Clin Endocrinol Metab. 1988. 66:343–348.

14. Yehuda R, Halligan SL, Yang RK, Guo LS, Makotkine I, Singh B, Pickholtz D. Relationship between 24-hour urinary-free cortisol excretion and salivary cortisol levels sampled from awakening to bedtime in healthy subjects. Life Sci. 2003. 73:349–358.

15. Papanicolaou DA, Mullen N, Kyrou I, Nieman LK. Nighttime salivary cortisol: a useful test for the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab. 2002. 87:4515–4521.

16. Misra M, Bredella MA, Tsai P, Mendes N, Miller KK, Klibanski A. Lower growth hormone and higher cortisol are associated with greater visceral adiposity, intramyocellular lipids, and insulin resistance in overweight girls. Am J Physiol Endocrinol Metab. 2008. 295:E385–E392.

17. Weigensberg MJ, Toledo-Corral CM, Goran MI. Association between the metabolic syndrome and serum cortisol in overweight Latino youth. J Clin Endocrinol Metab. 2008. 93:1372–1378.

18. Duclos M, Marquez Pereira P, Barat P, Gatta B, Roger P. Increased cortisol bioavailability, abdominal obesity, and the metabolic syndrome in obese women. Obes Res. 2005. 13:1157–1166.

19. Ward AM, Fall CH, Stein CE, Kumaran K, Veena SR, Wood PJ, Syddall HE, Phillips DI. Cortisol and the metabolic syndrome in South Asians. Clin Endocrinol (Oxf). 2003. 58:500–505.

20. Phillips DI, Barker DJ, Fall CH, Seckl JR, Whorwood CB, Wood PJ, Walker BR. Elevated plasma cortisol concentrations: a link between low birth weight and the insulin resistance syndrome? J Clin Endocrinol Metab. 1998. 83:757–760.

21. Anagnostis P, Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP. Clinical review: the pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metab. 2009. 94:2692–2701.

22. Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen TA. Association of adrenal steroids with hypertension and the metabolic syndrome in blacks. Hypertension. 2007. 49:704–711.

23. Rebuffe-Scrive M, Walsh UA, McEwen B, Rodin J. Effect of chronic stress and exogenous glucocorticoids on regional fat distribution and metabolism. Physiol Behav. 1992. 52:583–590.

24. Rebuffe-Scrive M, Krotkiewski M, Elfverson J, Bjorntorp P. Muscle and adipose tissue morphology and metabolism in Cushing's syndrome. J Clin Endocrinol Metab. 1988. 67:1122–1128.

25. Sen Y, Aygun D, Yilmaz E, Ayar A. Children and adolescents with obesity and the metabolic syndrome have high circulating cortisol levels. Neuro Endocrinol Lett. 2008. 29:141–145.

26. Rizza RA, Mandarino LJ, Gerich JE. Cortisol-induced insulin resistance in man: impaired suppression of glucose production and stimulation of glucose utilization due to a postreceptor detect of insulin action. J Clin Endocrinol Metab. 1982. 54:131–138.

27. Mangos GJ, Walker BR, Kelly JJ, Lawson JA, Webb DJ, Whitworth JA. Cortisol inhibits cholinergic vasodilation in the human forearm. Am J Hypertens. 2000. 13:1155–1160.

28. Dinneen S, Alzaid A, Miles J, Rizza R. Metabolic effects of the nocturnal rise in cortisol on carbohydrate metabolism in normal humans. J Clin Invest. 1993. 92:2283–2290.

29. Hollingdal M, Juhl CB, Dall R, Sturis J, Veldhuis JD, Schmitz O, Porksen N. Glucocorticoid induced insulin resistance impairs basal but not glucose entrained high-frequency insulin pulsatility in humans. Diabetologia. 2002. 45:49–55.

30. Mitchell BM, Webb RC. Impaired vasodilation and nitric oxide synthase activity in glucocorticoid-induced hypertension. Biol Res Nurs. 2002. 4:16–21.

31. DeSantis AS, DiezRoux AV, Hajat A, Golden SH, Jenny NS, Sanchez BN, Shea S, Seeman TE. Associations of salivary cortisol levels with metabolic syndrome and its components: the multi-ethnic study of atherosclerosis. J Clin Endocrinol Metab. 2011. 96:3483–3492.